Get Capabilities And Limitations Dification Form

Filling out the Capabilities And Limitations Dification Form online can streamline the process of documenting an individual's capabilities and limitations. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the form with ease.

1. Click the ‘Get Form’ button to access the form. This will allow you to retrieve and open the document in an online editor.
2. Begin by filling out the personal information section, which includes the employee's name (last, first, middle initial), gender, social security number, date of birth, job title, and control number.
3. In the current diagnosis section, enter the medical condition details and list any medications the individual is currently taking.
4. Indicate the percentage of the day that the following activities can be performed by checking the appropriate boxes: climbing, crawling, kneeling, lifting, and others specified in the form.
5. For each activity, specify whether it can be performed occasionally, frequently, continuously, or never by marking 'O,' 'F,' 'C,' or 'N' respectively.
6. Record the maximum weight the individual is capable of lifting by selecting from the provided weight categories.
7. Document any limitations regarding speaking, vision, depth perception, and hearing, providing explanations if necessary.
8. Fill out the total hours that the individual is capable of working per day and specify the duration of any restrictions.
9. Include additional comments that may be relevant to the individual's capabilities or limitations.
10. Ensure that the form is signed by the physician and dated appropriately.
11. Finally, review the completed form for accuracy, save your changes, and choose to download, print, or share the form as needed.

Start completing the Capabilities And Limitations Dification Form online today!