Form dshs14 144a 2025

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The Disability Report form DSHS 14-144A is used by social service or financial specialists to collect information about a client's disability, medical history, and work experience to assist the Division of Disability Determination in evaluating medical disability claims. The form includes sections for detailing the client's condition, medical records, activities, education, and work history, ensuring comprehensive data collection to support the disability decision process.

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Click ‘Get Form’ to open the DSHS 14-144A in the editor.
Complete the heading by entering the claimant's name, Social Security Number (SSN), and disabling condition.
Assist the client in filling out Part 1 - Information About Your Condition. Ensure dates reflect month and year accurately.
In Part 2 - Information About Your Medical Records, identify all physicians and treatment sources thoroughly.
Help the client complete Part 3 - Information About Your Activities, ensuring limitations are clearly stated.
For Part 4 - Information About Your Education, note if any schooling was special education.
In Part 5 - Information About the Work You Did, list types of businesses without naming individual employers.
Finally, assist in completing Item 1 in Part 6 - Remarks; Items 2 through 6 should be filled out by you as the specialist.

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Versions	Form popularity	Fillable & printable
2013	4.8 Satisfied (171 Votes)

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