Functional capacity evaluation form pdf download

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Functional capacity evaluation (FCE) is a systematic method of measuring an individual's ability to perform meaningful tasks on a safe and dependable basis. FCE includes all impairments. Form SSABK () ef () (Formerly SSAU8 Use prior editions) Page 1 Insured: (Date) PRIVACY ACT NOTICE: The information requested on this form is authorized by Section and Section of the Social Security Act. The information provided will be used in making a decision of this claim. Failure to complete this form may. m. Functional capacity evaluation. Note: It is ultimately the injured worker's decision to choose where a procedure/test will be conducted, subject to WCC-approved network restrictions. 6. Denial of Authorization - Form If the recommended diagnostic and/or treatment plan.

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