Functional Capacity Assessment???

Discussion in 'Fibromyalgia Main Forum' started by Dara, Jan 30, 2003.

  1. Dara

    Dara New Member

    I have been searching the internet for a "Functional Capacity Assessment" form. Does anyone know of any website where I can download a blank form? I searched the social security disability website thinking it would be on there, but couldn't find it. It's the form where you, or the doctor, estimate how long you can sit,stand, walk, etc, in an 8 hour day. Any help will be appreciated.

    Thanks,
    Dara
  2. Achy-shaky

    Achy-shaky New Member

    If it's the same form that is in Dr. Starlanyl's book "FM & CMP - A Survival Manual" you can find it if you do a search for "fibromyalgia impact assessment form" (it was the first hit in my MSN search engine) however it's in html format but you could copy and paste it into Word. In fact I want to put it into MS Word e-form format so it would be easier to fill out because I want to give it to all my doctors to have as SSD documentation - I just filed myself and need all the help I can get. If anyone wants the form, email me at mcmomma2002@yahoo.com & I'll send it as soon as I get it done. If anyone else out there has it already please let me know.
    Good luck on you SSD claim!!
  3. Dara

    Dara New Member

    no it's not really the same form. I also have the book, didn't even think to look in there for it, not thinking too good today! The one that I was looking for was given to me by the Vocational Rehabilitation Services. I just thought it might be somewhere obvious on the computer but guess not. This one is based on an 8 hour work day. It gives the doctor a choice of circling how many hours per day the patient can sit, stand, walk, bend, squat, crawl, climb, reach above, carry by weight, lift by weight, use feet for repetitive movements, use hands for repetitive movement, grasping, pushing & pulling, fine manipulation and then also gives a checklist of what activities the patient is restricted from doing, such as heights, moving machines, temperature & humidity, driving, exposure to dust, fumes & gases.

    I do thank you for responding to my question though, guess I'll have to go to the State office to see if I can pick up another blank form. Thanks again!!

    Dara
  4. Achy-shaky

    Achy-shaky New Member

    but I don't know where you'd get from but am interested in getting it myself so if you find it please email me at mcmomma2002@yahoo.com. If you say it's a state form maybe there's a state website that wouldhave it.
    Good luck!
  5. Dara

    Dara New Member

    from the Vocational Rehabilitation Services Department. This agency is a state agency that I believe every state has. I did search their website but was never able to find it on-line.

    Dara