Get Functional Capacity Evaluation (fce)

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.