Aetna insurance forms capabilities and limitations worksheet 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Employee Name, Gender, Social Security Number, Date of Birth, Job Title, and Control Number in the designated fields.
3. In the Current Diagnosis section, provide relevant medical information. List any medications being taken.
4. Indicate the percentage of time various activities can be performed using the provided scale (Occasional, Frequent, Continuous, or Never) for each activity listed.
5. Specify the maximum weight the patient can lift and detail any limitations regarding speaking, vision, depth perception, and hearing.
6. Complete additional sections regarding approved movements and whether the patient can operate vehicles or machinery.
7. Finally, ensure all required signatures are obtained before submitting the form.

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