RESIDUAL FUNCTIONAL CAPACITY WITH INJURY TO UPPER 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the claimant's name, claim number, and date of injury at the top of the form. This information is crucial for identification.
3. In the section for medical evaluator details, provide the name and specialty of the medical professional completing this assessment.
4. Fill in dates regarding when the claimant’s impairments became severe and when treatment began. This helps establish a timeline for their condition.
5. Answer questions about the claimant's ability to engage in competitive work, including how many hours they can sustain work each day considering their limitations.
6. Indicate if assistive devices are required and specify which ones. This section is vital for understanding additional support needs.
7. Complete sections on exertional physical demands, detailing capabilities related to sitting, standing, walking, lifting, carrying, pushing, and pulling.
8. Assess non-exertional physical demands such as climbing and balancing. Be honest about limitations to ensure accurate representation of capabilities.
9. Finally, review all entries for accuracy before saving or exporting your completed form using our platform's features.

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