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New railroad Retirement Board Disability and Social Security Disability Physical RFC Form

December 1, 2015 Blog

                   PHYSICAL RESIDUAL FUNCTIONAL CAPACITY QUESTIONNAIRE      RE:     Patient: _________________________________________________          SS#: ___________________________________________________   Please answer the following concerning your patient’s impairments and any reasonable restrictions. Frequency and length of contact: __________________________________________________________ Diagnoses: __________________________________ _____________________________________ ___________________________________ ________________________________ Prognosis: _________________________________________________________________________ List your patient’s symptoms, including pain, dizziness, fatigue, etc.:   ___________________________________________________________________ Identify […]