Get Physical Capabilities Form

Completing the Physical Capabilities Form online is a straightforward process designed to assess an individual's abilities and limitations regarding work-related activities due to physical or psychological conditions. This guide provides easy-to-follow steps to ensure that you accurately fill out the form, providing essential information to support the needs of the individual involved.

Follow the steps to fill out the Physical Capabilities Form online.

1. Press the ‘Get Form’ button to obtain the form and open it within your document editor.
2. Enter the FANF individual’s name, recipient identification (RID) number, and case number in the designated fields at the top of the form.
3. If applicable, check the box for hardship application as indicated.
4. Fill out the physician or clinician's details, including name, address, and phone number.
5. Complete Section 1 if you are treating the patient's physical condition. Provide the patient's name, diagnosis, date of onset of the condition, and prognosis.
6. Assess and circle the appropriate answers regarding the patient's ability to perform various physical activities, such as sedentary, light, medium, and heavy work.
7. Indicate the maximum daily time the patient can sit, stand, and walk, and note if any additional breaks are necessary.
8. Evaluate and check the patient's ability to lift, carry, kneel, bend, crouch, climb, and reach, providing details for each activity.
9. For Section 2, if applicable and treating the client's psychological condition, provide similar details including patient's name, diagnosis, and prognosis.
10. Rate the patient's abilities to perform psychological activities and check for any medications prescribed that may affect capabilities.
11. Finally, ensure all fields are filled out correctly, then save your changes. You can choose to download, print, or share the completed form as needed.

Complete the Physical Capabilities Form online today to support your assessment and help individuals in need.