Get Physical Medical Source Statement

The Physical Medical Source Statement is an important document that assesses an individual's ability to perform work-related activities. This guide provides clear, step-by-step instructions on how to fill out the form online, ensuring accuracy and completeness.

Follow the steps to successfully complete the form

1. Press the ‘Get Form’ button to access the Physical Medical Source Statement and open it in the online editor.
2. Begin by entering the individual's name and Social Security number in the designated fields at the top of the form.
3. In Section I, assess the individual's lifting and carrying abilities by checking the appropriate boxes for both lifting and carrying weights ranging from up to 10 lbs to 51-100 lbs.
4. In Section II, indicate how many hours the individual can sit, stand, or walk without interruption. Provide details on total time in an 8-hour workday and if the individual requires a cane.
5. In Section III, evaluate the use of hands for various tasks and indicate how often the individual can perform each activity. Identify the dominant hand.
6. Proceed to Section IV to assess the operation of foot controls. Mark the frequency for each foot and include supportive findings.
7. In Sections V and VI, evaluate postural activities and any impairments affecting hearing or vision. Provide detailed reasoning and medical findings for your assessments.
8. Complete Sections VII and VIII by indicating the individual's tolerance to environmental conditions and their ability to perform daily activities.
9. In Section IX, outline any work-related activities affected by impairments and provide the related medical findings.
10. At the end of the form, review all entries for accuracy, then either save your changes, download a copy of the completed form, print it, or share it as needed.

Complete your documents online to ensure a smooth filing process.