How to use or fill out dss 8655 of with our platform
- Click ‘Get Form’ to open the dss 8655 in the editor.
- Begin with Part I, filling in the Dist. No., Case No., DOB, Patient Name, SSN, Address, Date, and Case Manager's contact information.
- In Part II, authorize the release of your medical information by signing and dating the section as the Applicant, Recipient, Personal Representative, or Guardian.
- Proceed to Part III for the Medical Report. The physician will need to indicate if there are any medical or psychological conditions affecting work capacity by selecting YES or NO.
- If YES is selected, complete sections A through H with detailed information about diagnosis, prognosis, current medications, work capacity restrictions, and vocational rehabilitation eligibility.
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What does the NC Department of Health and Human Services do?
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