Purpose
|
The Department of Social and Health Services (DSHS), Division of Disability Determination Services (DDDS), administers the Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), and DSHS Non-Grant Medical Assistance programs. The purpose of this Request for Qualifications (RFQ) is to expand the list of qualified, contracted physicians to perform medical examinations for claimants who apply for these benefits. |
---|---|
Contact Name
|
Uyen Kashani, Professional Relations Specialist |
Contact Email and Address
|
Uyen.Kashani@ssa.gov Department of Social and Health Services Economic Services Administration Division of Disability Determination Services P.O. Box 9303 Olympia, WA 98507-9303 |
Contact Phone and Fax
|
(360) 584-6630 - Office (833) 656-1248 - Fax |
Submissions
|
If you are interested in becoming a Consultative Examiner, please submit your application packet to the above address or fax number, Attn: Matthew Delozier. * As of 12/1/2023, we are not accepting new applications in King County. |
Documents
RFQ # 1436-522 ESA Medical and Psychological Services
DDDS Consultative Medical Examinations
For single physician performing work, complete:
- Exhibit A1 – Application Checklist
- Exhibit B1 – Statement of Agreement
- Exhibit C1 – Acknowledgement of Professional Qualifications
For a group of physicians performing work, complete:
- Exhibit A2 – Application Checklist
- Exhibit B2 – Statement of Agreement
For each physician within a group of physicians performing work, complete:
- Exhibit A3 – Application Checklist
- Exhibit B3 – Statement of Agreement
- Exhibit C3 – Acknowledgement of Professional Qualifications
Remaining Exhibits to RFQ:
- Exhibit D – Contractor Intake
- Exhibit E – Applicant Certification and Assurances
- Exhibit F – Sample Contract – DDDS Consultative Medical Examinations
- Exhibit G – Cardiology Specialty Examination
- Exhibit H – Dermatology Specialty Examination
- Exhibit I – Neurology Specialty Examination
- Exhibit J – Orthopedic Specialty Examination
- Exhibit K – Pediatric Specialty Examination
- Exhibit L – Respiratory Specialty Examination
- Exhibit M – Rheumatology Specialty Examination