Common functional limitations checklist 2026

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  1. Click ‘Get Form’ to open the Common Functional Limitations Checklist in the editor.
  2. Begin by reviewing each section of the checklist, which covers various disabilities and their associated limitations. Familiarize yourself with the specific limitations listed under each category.
  3. For each limitation, mark 'Yes', 'No', or 'Don’t Know' based on your personal experience. This will help you identify areas that may require further discussion or support.
  4. In the provided space, detail how you plan to address any items marked 'Yes'. This could include strategies for coping or accommodations needed in your daily life.
  5. Once completed, save your checklist. You can easily share it with healthcare providers or support teams directly from our platform.

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Functional limitations are commonly evaluated with tests of physical performance using objective, standardized procedures. Gait speed evaluated over 4 m is among the most common physical performance test used in older adults.
Functional limitation: Reported level of difficulty in six domains of functioning: seeing (even if wearing glasses), hearing (even if wearing hearing aids), mobility (walking or climbing stairs), communication (understanding or being understood by others), cognition (remembering or concentrating), and self-care (such
Disabilities generally fall into four main categories: physical, sensory, intellectual/developmental, and mental/behavioral.
(3) We have identified four broad functional areas in which we will rate the degree of your functional limitation: Understand, remember, or apply information; interact with others; concentrate, persist, or maintain pace; and adapt or manage oneself.

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