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Click ‘Get Form’ to open the dis certificate in the editor.
Begin by entering the 'Name of Person Examined' in the designated field. Ensure accuracy as this information is crucial for identification.
Next, input the 'Social Security Number' and 'Address', including street, city, state, and zip code. This information helps verify eligibility for homestead benefits.
Respond to question 1 regarding disability qualification by selecting either 'YES' or 'NO'. This determines if the individual meets the criteria for claiming benefits.
In section 2, describe the nature of the disability in detail. Be specific to provide a clear understanding of the condition.
Indicate when the condition was originally diagnosed in section 3. Accurate dates are essential for processing claims.
The physician must complete their certification by filling in their name, signature, business address, phone number, and date at the bottom of the form.

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Versions	Form popularity	Fillable & printable
2023	4.9 Satisfied (57 Votes)
2022	4.6 Satisfied (34 Votes)
2021	4.8 Satisfied (213 Votes)
2020	4.3 Satisfied (88 Votes)

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How do you become a disease intervention specialist?

The qualifications for a career as a disease intervention specialist include a bachelors degree in epidemiology or public health and policy and work experience in the health field. After completing your education, you can get specialized job training through the organization for which you work.

What is a DIS certificate?

Disease Intervention Specialist Certification. Feb 01, 2023. NACCHO is working with the CDC Division of STD Prevention, the National Coalition of STD Directors, and the Public Health Accreditation Board to develop a national certification program for disease intervention specialists (DIS).

What is dis training?

This course is designed to introduce Disease Intervention Specialists (DIS) to the principles and strategies of trauma-informed care, so they are equipped with the knowledge and tools necessary to support clients who have experienced trauma.