Residual Functional Capacity Childhood Mental Disorders

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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.
Lee Ann Torrans
Residual Functional Capacity
Childhood Mental Disorders
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:
The “Whole Child Approach” of the Social Security Administration:
A child who applies for Supplemental Security Income (SSI) is “disabled” if the child is not
engaged in substantial gainful activity and has a medically determinable physical or mental
impairment or combination of impairments that results in “marked and severe functional
limitations.” 20 CFR 416.906. This means that the impairment(s) must meet or medically equal a
listing in the Listing of Impairments (the listings), or functionally equal the listings (also referred
to as “functional equivalence”). To functionally equal the listings, an impairment(s) must be of
listing-level severity; that is, it must result in “marked” limitations in two domains of functioning
or an “extreme” limitation in one domain. 20 CFR 416.926 a (a). Domains are broad areas of
functioning intended to capture all of what a child can or cannot do.
The six domains considered by the SSA in determining impairments that result in marked and
severe functional limitations have been examined and included in this review:
(1) Acquiring and using information,
(2) Attending and completing tasks,
(3) Interacting and relating with others,
(4) Moving about and manipulating objects,
(5) Caring for yourself, and
Mental Functional Assessment – Page Number 1

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