This questionnaire, provided by attorney Leslie Kline-Capelle, formerly of Health Advocates, is intended to assist with a determination of disability for purposes of obtaining social security disability benefits. In order to be effective, the form must be completed by a medical doctor (in this case, a psychiatrist) who is treating the individual applying for benefits. Although not HIV/AIDS specific, the form, if properly completed, may be a helpful piece of evidence in a case being heard by an administrative law judge (ALJ).
CHLP fights stigma and discrimination at the intersection of HIV, race, health status, disability, class, sexuality and gender identity and expression, with a focus on criminal and public health systems. As part of this work, we support movement building that amplifies the power of individuals and communities to mobilize for change rooted in racial, gender and economic justice. We do this through legal advocacy, high-impact policy initiatives, and creation of cross-issue partnerships, networks, and resources.