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dhs

DHS


PROTECT YOUR BENEFITS. Learn more


The District of Columbia’s Department of Human Services’ guidance on Monkeypox. Learn more
 

coronavirus.dc.gov

 

 

Medical Examination Report


Friday, February 16, 2018

The information provided in this form will be used to determine eligibility for benefits requiring a finding of disability under the Social Security disability criteria. Please focus your responses on the atient’s ability to perform work functions.