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Get Estimated Functional Capacity Evaluation
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How to fill out the Estimated Functional Capacity Evaluation online
Filling out the Estimated Functional Capacity Evaluation is an important step in assessing a person's ability to work. This guide provides a clear step-by-step process to ensure you complete the form accurately and efficiently.
Follow the steps to successfully complete the form.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by filling in the patient's information at the top of the form, including their name, date of birth, and any relevant case number.
- Proceed to the work capacity section where you will estimate the individual's lifting abilities. Select the relevant options for each weight category ranging from 10 pounds to over 100 pounds, marking how often the person is able to lift.
- In the carrying section, similarly mark the frequency at which the individual can carry designated weights. Ensure all responses reflect a true assessment of their ability.
- Continue to the next tasks, where you will evaluate their ability to perform physical actions such as pushing, pulling, bending, and climbing. Indicate the frequency for each action within the given choices.
- Evaluate the person's expected work capacity for an 8-hour workday in different activities: sitting, standing, walking, and alternating positions. Specify the number of hours for each activity, noting that the total can be less than 8.
- Address the ability to use hands for repetitive actions. Respond with 'Yes' or 'No' for each hand and action type, specifying grip strength where applicable.
- Assess the capability to perform foot movements necessary for operating controls, noting if applicable for each foot.
- Indicate any potential restrictions regarding specific activities, including exposure to heights, moving machinery, temperature changes, and other environmental factors.
- Conclude by answering the questions about the person's ability to continue in their current job or return to other work, and indicate any relevant disability rating.
- Fill in the physician's information, including name, address, and license details. Ensure to sign and date the form before submission.
- Once all sections are completed, review the form for accuracy, then save changes, download, print, or share the completed form as necessary.
Complete your documents online to streamline the assessment process.
A Functional Capacity Evaluation is generally completed by licensed professionals such as occupational or physical therapists. These specialists are trained to assess an individual's abilities and limitations related to daily tasks, aligning their assessments with the needs of the Estimated Functional Capacity Evaluation. Their expert evaluations provide crucial insights for treatment planning and insurance claims.
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