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MISSISSIPPI Mental Health Center where he is being followed, or secure medical information from other sources, and describe any bizarre or abnormal behavior of the individual in the social report. If the Unit wishes to request the State Hospital's summary, their request will authorize payment for the additional report. ∙ Regional Mental Health Centers. Use form MDHS-EA-333 to request an evaluation and report or a report only when the individual has been evaluated or treated at the Center within the previous twelve months. Role of Examining Physician The private physician who completes the physical examination of the individual on form MDHSEA331, Report of Medical Examination, is asked to furnish the following: 1. The medical findings describing the impairment or illness. 2. A diagnosis of the individual's physical or mental problem.

MISSISSIPPI [NON-FINANCIAL CRITERIA: DEPRIVATION]

Volume III | Chapter 3 Revised 08-01-06

3. A description of the treatment and its effect on the individual or recommendation for treatment. 4. A statement as to whether an examination by a specialist or special tests are indicated. 5. A statement of how the individual’s condition affects his ability to work or to participate in the TANF Work Program, including the anticipated duration of the disability which prevents the individual from working. The physician is not asked to make a decision as to whether the individual is qualified for incapacity in TANF. The definitions used in making the eligibility decision are not available to the examining physician. NOTE: The MDHS-EA-331, Report of Medical Examination, may be signed by a Licensed Nurse Practitioner, who is currently involved in the client’s treatment. Submitting Information for Applications