Ldss 4526-2025

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The document LDSS-4526 is a medical examination form used by the New York State Office of Temporary and Disability Assistance for assessing employability, disability screening, and determining alcoholism or drug addiction. It includes sections for client identification, authorization for medical information release, detailed medical history, functional limitations, treatment history, current treatment program identification, work activity limitations, SSI referral screening, and physician information. The form aims to gather comprehensive medical data to evaluate the client's eligibility for assistance.

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Versions	Form popularity	Fillable & printable
2010	4.8 Satisfied (101 Votes)
1998	4 Satisfied (33 Votes)

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