Doh 5139-2025

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The document is a Disability Questionnaire from the New York State Department of Health's State Disability Review Unit. It collects detailed information about an individual's medical conditions, treatment history, education, communication abilities, and work experience to assess eligibility for disability benefits. The questionnaire includes sections on personal identification, medical records, educational background, and past employment.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (97 Votes)
2017	4.2 Satisfied (78 Votes)

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