Home
Forms Library
Physical capacity form

Physical capacity evaluation form 2025

physical capacity form Preview on Page 1

Show details

4 out of 5

49 votes

The document is a Physical Capacities Evaluation Form for Jane Smith, assessing her eligibility for Social Security disability benefits due to her secondary progressive Multiple Sclerosis. It includes detailed questions regarding her medical history, symptoms, limitations in daily activities, and the impact of her condition on her ability to work. The physician provides specific observations about Jane's physical capabilities, including her inability to stand or sit for extended periods, challenges with mobility and fine motor skills, and the necessity for frequent rest due to fatigue. The prognosis indicates a steady decline in her condition, confirming that she cannot perform any gainful work.

Here's how it works

01. Edit your physical capacity form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send capacity evaluation template via email, link, or fax. You can also download it, export it or print it out.

How to quickly redact Physical capacity evaluation form online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Dochub is the best editor for updating your documents online. Adhere to this straightforward instruction to redact Physical capacity evaluation form in PDF format online for free:

Sign up and sign in. Register for a free account, set a strong password, and proceed with email verification to start working on your templates.
Add a document. Click on New Document and choose the form importing option: upload Physical capacity evaluation form from your device, the cloud, or a protected URL.
Make changes to the template. Utilize the top and left-side panel tools to edit Physical capacity evaluation form. Insert and customize text, pictures, and fillable fields, whiteout unnecessary details, highlight the important ones, and provide comments on your updates.
Get your paperwork done. Send the form to other parties via email, generate a link for faster file sharing, export the template to the cloud, or save it on your device in the current version or with Audit Trail added.

Discover all the benefits of our editor right now!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I get an RFC?

Applicants must visit their local SAT office in person for RFC registration. SAT only accepts applications through prior appointments, which can be requested online. In regions where appointments are unavailable, individuals can join a waiting list, receiving email notifications when appointments become accessible.

What is a physical capacity evaluation?

Physical Capacity Evaluation (PCE) A three-hour assessment of physical abilities, inclusive of: lifting, carrying, ambulation, and stairs, sitting and standing tolerances, pushing and pulling.

Can any doctor fill out a RFC form?

The Disability Determination Services (DDS) physician completes the RFC form, but you can also have your own doctor fill out an RFC on your behalf. This can be helpful because forms completed by DDS physicians are typically written to be highly critical of claims for disability benefits.

Can a therapist fill out an RFC form?

The agency values any input your doctors provide that can help shed light on your limitations and make sure your RFC assessment is accurate. You can even print out a blank physical RFC or mental RFC form to give to your doctor, counselor, or therapist for them to fill out.

How do I get an RFC form?

Many insurances will pay for some or all of the FCE if it is necessary. However, if you are planning on paying out of pocket you will be spending at least $575 at WorkSafe Physical Therapy for a functional capacity evaluation.

physical capacity evaluation form

Functional Capacity Evaluation form pdf Work Capacity Evaluation form Functional capacity Evaluation form for disability Functional capacity Evaluation Physical Therapy pdf Sample functional Capacity Evaluation report VA Work Capacity Evaluation form Functional capacity evaluation scoring physical capacity form h-e-b