Michigan's Disability Determination Service (DDS) certifies disability for State Disability Assistance, Medicaid and Family Independence Program deferrals, and the DHS-49 is its standard physical exam report. The treating physician reports history, exam findings, diagnoses and physical limitations. DDS weighs it with the client's questionnaire and records, then records its decision on the DHS-49-A.
An M.D. or D.O., normally the treating physician, completes and signs the whole form; evidence from a physician assistant must be co-signed by an M.D. or D.O. The client completes the separate DHS-49-F questionnaire and DHS-1555 release.
Download the current version from the source each time; forms change without notice.
Medical Examination Report
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
It is not posted publicly. The MDHHS local office or the Disability Determination Service sends it to the physician for a specific client's case, alongside the client's DHS-49-F Medical-Social Questionnaire and DHS-1555 release. Return it to the office that sent it.
Michigan policy says medical evidence of disability must be based on the findings of an M.D., D.O. or fully licensed psychologist. Any medical evidence submitted by a physician assistant must be co-signed by an M.D. or D.O. before DDS relies on it.