Residual Functional Capacity - Adult Bi-Polar Mental Disorder printable pdf download

Residual Functional Capacity - Adult Bi-Polar Mental Disorder

THESE ARE THE FORMS I USE – THIS IS NOT LEGAL ADVICE AND INTENDED TO

SUPPLEMENT YOUR PARTICULAR FACTUAL SITUATION ONLY – It is crucial you educate

yourself on the Social Security Regulations that define and govern impairments prior to preparing this

form for review. These forms are used to enhance the provider’s understanding of the purpose of the

assessment and the impact of their evaluation. It includes SSA definitions while combining the

traditional SSA standard form.

This form addresses only Bipolar Disorder. As an attorney or an individual representing yourself it is

important to combine multiple diagnoses in your RFC, if they are present and diagnosed. The Surgeon

General estimated that about one half of those who have a primary diagnosis of major depression also

have an anxiety disorder. Comorbidities of multiple mental diagnoses and combined physical

diagnoses are common. Mental diagnoses include substance abuse, mood disorder and personality

disorders, and often combined with physical illnesses. A federal district court has recognized the

mental health disease of schizoaffective disorder as a combination of schizophrenia and bipolar

disorder, resulting in severe changes in mood and some of the psychotic symptoms of schizophrenia,

such as hallucinations, delusions, and disorganized thinking.

Lee Ann Torrans

RESIDUAL FUNCTIONAL CAPACITY – ADULT

BI-POLAR MENTAL DISORDER

Name:

SSN:

DOB:

Health Care Provider Name:

Health Care Provider Relationship to Patient:

When First Treated Patient:

How Often Sees Patient:

Primary Diagnosis:

Date of Onset*:

Secondary Diagnosis:

Date of Onset:

Other Impairments:

Date of Onset:

Date of Onset is defined as the first day the claimant meets the definition of disability as defined in the Act and regulations.

Purpose of Medical Evidence and of RFC:

(1) Establish the presence of a medically determinable mental impairment(s),

(2) Assess the degree of functional limitation the impairment(s) imposes, and

(3) Project the probable duration of the impairment(s).

RFC is based upon:

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Residual Functional Capacity - Adult Bi-Polar Mental Disorder