When a Michigan client claims disability based on a mental health condition, the Disability Determination Service (DDS) relies on the DHS-49-D. A psychiatrist or fully licensed psychologist reports mental status, diagnoses and prognosis, and DDS uses it with the DHS-49-E functional assessment to decide State Disability Assistance, Family Independence Program deferral or Medicaid disability.
A psychiatrist (M.D. or D.O.) or fully licensed psychologist completes the whole report. The client completes the separate DHS-49-F questionnaire and signs the DHS-1555 release.
Download the current version from the source each time; forms change without notice.
Psychiatric/Psychological Examination Report
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A psychiatrist who is an M.D. or D.O., or a fully licensed psychologist. Michigan's eligibility manual requires medical evidence of disability to be based on the findings of an M.D., D.O. or fully licensed psychologist, and the DHS-49-D is the mental health exam report used for that evidence.
The DHS-49-D is the examination report: mental status, diagnoses and prognosis. The DHS-49-E is the Mental Residual Functional Capacity Assessment, which addresses the person's remaining mental capacity for work. Michigan policy requests them together for mental health conditions.