We use cookies to improve security, personalize the user experience, enhance our marketing activities (including cooperating with our marketing partners) and for other business use.
Click "here" to read our Cookie Policy. By clicking "Accept" you agree to the use of cookies. Read less
Read more
Accept
Loading
Form preview
  • US Legal Forms
  • Form Library
  • More Forms
  • More Multi-State Forms
  • Functional Capacity Evaluation (fce)

Get Functional Capacity Evaluation (fce)

RESIDUAL FUNCTIONAL CAPACITY WITH INJURY TO UPPER EXTREMITY (IES) Name: Claim #: Date of Injury: Please Print Name of Medical Evaluator: Medical Specialty: What is the first date claimant s impairment(s).

How it works

  1. Open form

    Open form follow the instructions

  2. Easily sign form

    Easily sign the form with your finger

  3. Share form

    Send filled & signed form or save

How to use or fill out the FUNCTIONAL CAPACITY EVALUATION (FCE) online

The Functional Capacity Evaluation (FCE) is an essential document that assesses an individual's ability to perform work-related tasks following an injury. This guide provides step-by-step instructions for filling out the FCE online, ensuring clarity and support throughout the process.

Follow the steps to complete the FCE online effectively.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Begin by entering the claimant's personal information including their name, claim number, and date of injury.
  3. Provide details about the medical evaluator, their name, and specialty.
  4. Indicate the date when the claimant's impairment became severe enough to interfere with activities of daily living (ADLs) or work.
  5. Record the start date of treatment for the claimant and the frequency of consultations.
  6. Evaluate the claimant's ability to engage in sustained competitive work by selecting 'Yes' or 'No.'
  7. Specify how many hours the claimant can reasonably expect to sustain competitive work based on identified vocational compatibility.
  8. Indicate whether assistive devices are needed, and specify the types required.
  9. Identify the claimant's dominant and affected upper extremities.
  10. Complete the exertional physical demands section, including sitting, standing, walking, and driving time expectations.
  11. Fill out details regarding lifting, carrying, pushing, and pulling capabilities for both the right and left sides.
  12. Assess non-exertional physical demands, including actions related to climbing, balancing, kneeling, etc.
  13. Document findings on upper extremity usage during an 8-hour workday including activities such as simple grasping and fine manipulation.
  14. Assess the degree of pain experienced while performing tasks requiring fine manipulation.
  15. Evaluate the capacity for neck and head actions, and lower extremity usage.
  16. Document the need for medication side effects and their impact on work capabilities.
  17. Enter any necessary details about managing and relieving pain and specify breaks or changes in position needed during work hours.
  18. Conclude by providing the physician's signature and date.

Complete your FCE online today for a comprehensive assessment of functional capacity.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Get form

Related content

Functional Capacity Evaluation & Disability - NCBI...
by JJ Chen · 2007 · Cited by 70 — One can use an FCE to develop a treatment program...
Learn more
Functional Capacity Evaluations | Department of...
A Functional Capacity Evaluation (FCE) is a systematic process of assessing an...
Learn more
FCEMatrix - UserManual.wiki
Dec 2, 2015 — ... Physical Work Performance Evaluation (PWPE) EvalTech JTECH Tracker FCE...
Learn more

Related links form

BIO DATA FORM - Repco Home Finance Request For Letter Of Permission Form - Booth University College Lrng Target Template Fin Rvsd Form 6 Regulation 7(4) DECLARATION OF LOST, STOLEN OR ...

Questions & Answers

Get answers to your most pressing questions about US Legal Forms API.

Contact support

The length of the window depends on the exam you have taken, but it is usually around two weeks long. Results release windows for paper-based exams normally start around four to five weeks after the exam date. Results release windows for computer-based exams normally start about two weeks after the exam.

Once your FCE is complete, the report has to be dictated and/or typed up by the examiner's office and then your workers' comp doctor has to approve the exam and the permanent restrictions set forth. Once this is done a copy of the report can be obtained.

During the test, the physician will test a number of elements of your physical strength necessary to perform your job, including the following: Pulling, pushing, lifting, and carrying materials. Squatting, walking, kneeling, reaching, standing, balancing, crawling, bending, sitting.

A functional capacity exam is an assessment of whether you can work or return to work. It involves a series of standardized physical tests that are typically administered by a physical or occupational therapist. These tests are designed to evaluate your physical abilities as they relate to work.

A functional capacity evaluation (FCE) evaluates an individual's capacity to perform work activities related to his or her participation in employment (Soer et al., 2008). The FCE process compares the individual's health status, and body functions and structures to the demands of the job and the work environment.

What Happens During an FCE Test? ... During the test, the physician will test a number of elements of your physical strength necessary to perform your job, including the following: Pulling, pushing, lifting, and carrying materials. Squatting, walking, kneeling, reaching, standing, balancing, crawling, bending, sitting.

Be prepared for the length of the FCE. A functional capacity evaluation can take four to six hours, although the process can take longer or take less time, depending on what is being tested. Some FCEs are carried out over two days.

A Functional Capacity Evaluation ( FCE ) involves a battery of objective of tests, practices, and observations to evaluate your physical ability to function in different areas. The final report can help demonstrate the aggregate impact of your symptoms on your ability to perform essential work functions.

A functional capacity evaluation (FCE) evaluates an individual's capacity to perform work activities related to his or her participation in employment (Soer et al., 2008). The FCE process compares the individual's health status, and body functions and structures to the demands of the job and the work environment.

You might think you've failed your FCE test if the examiner determines that you are unable to perform tasks essential to the work you did before your injury. The examination report might have such stringent restrictions that you won't be able to go back to work at all, and will have to file for total disability.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Get form
If you believe that this page should be taken down, please follow our DMCA take down processhere.

Fill FUNCTIONAL CAPACITY EVALUATION (FCE)

A Functional Capacity Evaluation (FCE) is an evaluation of a person's functional capacity in relation to a job's demands. Functional capacity evaluations (FCE) are comprehensive tests that assess the physical abilities of people who have suffered a work-related injury. An assessment process used to assess work capability. The FCE program assesses the abilities of workers who have suffered injuries that could affect their employment opportunities. A functional capacity evaluation (FCE) is a standard assessment that measures your physical abilities in relation to your typical job tasks.

Industry-leading security and compliance

US Legal Forms protects your data by complying with industry-specific security standards.
  • In businnes since 1997
    25+ years providing professional legal documents.
  • Accredited business
    Guarantees that a business meets BBB accreditation standards in the US and Canada.
  • Secured by Braintree
    Validated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.
Get FUNCTIONAL CAPACITY EVALUATION (FCE)
Get form
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232