Form Ssa-4734-F4-Sup - Mental Residual Functional Capacity Assessment Page 3
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Ill. FUNCTIONAL CAPACITY ASSESSMENT
Record in this section the elaborations on the preceding capacities. Complete this section ONLY after the SUMMARY
CONCLUSIONS section has been completed. Explain your summary conclusions in narrative form. Include any information
which clarifies limitation or function. Be especially careful to explain conclusions that differ from those of treating medical sources
or from the individual's allegations.
Continued on Page 4
MEDICAL CONSULTANT'S SIGNATURE
DATE
SSA-4734-F4-SUP
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Parent category: Medical