Get Pulmonary Residual Functional Capacity Questionnaire

The Pulmonary Residual Functional Capacity Questionnaire is a crucial document used to assess a person's ability to perform work-related physical activities. This guide will provide step-by-step instructions on how to complete this form online, ensuring accuracy and clarity.

Follow the steps to successfully complete the questionnaire online.

1. Locate the ‘Get Form’ button and press it to obtain the Pulmonary Residual Functional Capacity Questionnaire. Once you have the form, open it in your preferred online editor.
2. Begin with the patient’s information section, where you will need to input the patient’s name and Social Security Number (SSN). Ensure all entered information is accurate.
3. For question 1, record how many pounds the patient can lift and carry in a competitive work setting by selecting from the options provided, such as 'Never,' 'Occasionally,' or specific weight limits.
4. Question 2 requires you to identify all symptoms your patient experiences. Check all applicable boxes, including options like 'Fatigue,' 'Wheezing,' and 'Shortness of Breath.'
5. In question 3a, list the precipitating factors for acute asthma attacks by checking any that apply, including 'Exercise' or 'Cold air & change in weather.' Fill out parts b, c, and d regarding the nature, frequency, and duration of attacks.
6. Question 4 asks if the patient experiences 'good days' and 'bad days.' Select 'Yes' or 'No', and if applicable, estimate the frequency of work absences.
7. For question 5, mark the degree to which the patient should avoid exposure to various conditions, ranging from 'No Restriction' to 'Avoid All' for items like 'Extreme Cold' and 'Cigarette Smoke.'
8. In question 6, estimate the patient's functional limitations by selecting appropriate time frames for sitting or standing within an 8-hour workday.
9. Question 7 inquires if the patient is a malingerer, select 'Yes' or 'No'.
10. In question 8, provide any additional limitations affecting the patient's ability to work.
11. Lastly, fill in the duration the patient has been functioning at this level and the primary diagnosis. Sign and date the form as required.
12. After completing all sections, review the form for accuracy. Save changes, download, print, or share the questionnaire as needed.

Complete your Pulmonary Residual Functional Capacity Questionnaire online today for a simpler process.