Washington DSHS asks an examining provider to complete this evaluation when it decides whether a client is incapacitated for state-funded Aged, Blind or Disabled cash assistance or a Housing and Essential Needs referral. The provider records symptoms, findings and each diagnosis with a severity rating for basic work activities, then states the work level the client can sustain and how long the limitation will last.
The examining physician, ARNP or PA completes the clinical sections, from subjective history through the assessment and plan, and signs, with a line for a reviewing and adopting professional. The client signs the Section B authorization to release information.
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Physical Functional Evaluation
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DSHS reimburses a general or comprehensive physical evaluation through ProviderOne, so the examining provider must be enrolled there. Payment is contingent on receiving available chart notes from the past six months and supporting evidence, including lab results, pathology reports, diagnostic imaging reports and range of motion studies.
The provider picks the level the client can perform in a regular, predictable manner: heavy, medium, light, sedentary or severely limited. Each level is defined by maximum and frequent lifting weights and by standing and walking tolerance, and the provider estimates in months how long the limitation will last with treatment.
Yes. The form states that the information is subject to Washington public disclosure laws and may be released to the client on request. DSHS otherwise discloses it only with the client's written consent or as state law allows.