Adults in the Alaska Temporary Assistance Program (ATAP) are expected to work or take part in work activities, and this two-page report tells the Division of Public Assistance what a physical or mental condition allows. The clinician states whether the condition limits work, whether full- or part-time hours are possible, how long the limitation will last and what activities suit the person.
A licensed health care professional completes both pages after the patient identification block and signs. The caseworker uses the answers with the TA 5 Employability Assessment and the family's TA 2 self-sufficiency plan.
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Health Status Report Form
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The Division of Public Assistance uses it for adults in the Alaska Temporary Assistance Program. The health care professional's answers on work limits, hours, duration and suitable activities help the caseworker decide on work exemptions and build the family self-sufficiency plan.
A licensed health care professional who can evaluate the patient's physical or mental condition. They complete both pages after the identification block, sign, and send the form by fax or mail to the DPA representative named at the end of the form.