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Purpose
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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 health professionals to perform diagnostic examinations for claimants who apply for these benefits. |
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Contact Name
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Uyen Kashani, Professional Relations Specialist |
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Contact Email and Address
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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 |
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Contact Phone and Fax
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(360) 584-6630 - Office (833) 656-1248 - Fax |
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Submissions
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If you are interested in becoming a Consultative Examiner, please submit your application packet to the above address or fax number, Attn: Matthew Delozier. |
Documents
RFQ # 1436-522 ESA Medical and Psychological Services
DDDS Consultative Medical Examinations – Otolaryngology/Audiology/Vision
For single health professional performing work, complete:
- Exhibit A1 – Application Checklist
- Exhibit B1 – Statement of Agreement
- Exhibit C1 - Acknowledgement of Professional Qualifications
For a group of health professionals performing work, complete:
For each health professional within a group of health professionals 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 Form
- Exhibit E – Applicant Certification and Assurances
- Exhibit F – Sample Contract – DDDS Consultative Medical Examination – OTO/AUD/Vision
- Exhibit G – Otolaryngology Specialty Examination
- Exhibit H – Audiology Specialty Examination
- Exhibit I – Vision Specialty Examination