Get Residual Functional Capacity Chart

This guide provides clear and supportive instructions for users who are completing the Residual Functional Capacity Chart online. Each section and field will be explained in detail, ensuring that you can accurately report your functional capacity.

Follow the steps to fill out the Residual Functional Capacity Chart effectively.

1. Click 'Get Form' button to obtain the Residual Functional Capacity Chart and open it in your online editor.
2. In the first section, enter your name and Social Security number. This information is essential for identifying your case.
3. For the assessment period, check the appropriate box to indicate whether this is for the current evaluation or for 12 months after onset.
4. In the summary conclusions section, evaluate each listed mental activity's limitations based on the individual’s capacity to sustain that activity over a regular workday.
5. Fill in the degree of limitation (Not significantly limited, Moderately limited, Markedly limited, No evidence of limitation, Not ratable) for each activity in categories A through D.
6. If any rating category is marked as 'Markedly limited,' provide specific evidence in Section II regarding what additional documentation is necessary for assessment.
7. In the Functional Capacity Assessment section, elaborate on the capacities you've rated previously. Use narrative form to clarify any limitations and to provide context, especially if differing from medical opinions.
8. Review all sections and ensure that they are accurately filled out before saving your changes.
9. Once all fields are complete, download, print, or share the form as needed, depending on how you wish to submit your application.

Start filling out your Residual Functional Capacity Chart online today!