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How to use or fill out hawaii dhs 1128 form with our platform
- Click ‘Get Form’ to open the Hawaii DHS 1128 form in the editor.
- Begin by filling in the patient's name, date of birth, and sex in Section I. Ensure all information is accurate and legible.
- In Section II, describe all significant physical and mental conditions related to the patient's disability. Be thorough and attach any relevant reports.
- List current diagnoses in Section III, starting with the primary diagnosis. Use clear language for each entry.
- Outline your treatment plan and its duration in Section IV. Provide detailed information to support your recommendations.
- In Section V, explain the patient’s functional limitations regarding work capabilities based on medical evidence.
- Complete Section VI by indicating the expected duration of the disability and signing as the licensed physician.
- Finally, have the patient acknowledge their understanding by completing Section VII with their signature and contact number.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2009 | 4.8 Satisfied (128 Votes) |
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