Aetna insurance forms capabilities and limitations worksheet 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Employee Name (Last, First, Middle Initial) in the designated field. Ensure accuracy as this is a required entry.
3. Select the Gender by checking either Male or Female. This helps in personalizing the insurance assessment.
4. Fill in the Social Security Number and Date of Birth (MM/DD/YYYY). These details are crucial for identification purposes.
5. Provide your Job Title and Control Number, if applicable, to assist with processing your claim.
6. In the Current Diagnosis section, briefly describe any medical conditions affecting your work capabilities.
7. List any Medications you are currently taking that may impact your performance at work.
8. Indicate the percentage of time you can perform various activities by marking O (Occasional), F (Frequent), C (Continuous), or N (Never) for each activity listed.
9. Specify the Maximum weight you can lift from the provided options. This helps assess physical limitations.
10. Complete any additional comments regarding limitations on speaking, vision, hearing, etc., as needed.
11. Finally, ensure to sign and date the form where indicated to validate your submission.

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