Residual Functional Capacity Childhood Mental Disorders Page 7
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8Moving about and manipulating objects. This domain looks at the child’s ability to perform
physical functions like sitting, standing, balancing, shifting weight, bending, crawling, running,
and transferring. It also includes the ability to hold, carry, and manipulate objects, as well as the
capacity to plan, remember and execute movements. Also considered are the child’s
coordination, dexterity, and integration of sensory input.
Level of Impairment:
Mild
Slight
Moderate
Severe
Other
Not Able to Assess
Child’s Ability to Care for Him/Herself
Measure the child’s ability to care for his or her physical needs and to maintain a healthy
emotional state. It includes the ability to care for one’s own health and safety and to cooperate
with others to meet one’s needs. It also incorporates the concept that the child should be
developing an increasing sense of independence and competence.
Level of Impairment:
Mild
Slight
Moderate
Severe
Other
Not Able to Assess
Health and physical well-being. What are the cumulative physical effects of physical and/or
mental impairments. Considered are the effects of chronic illness, including shortness of breath,
reduced stamina, pain and poor growth. Also includes are the impact of therapies, medications
and periods of exacerbation and remission.
Level of Impairment:
Mild
Slight
Moderate
Severe
Other
Not Able to Assess
MEDICATIONS
List Prescribed Medications and identify condition for which medications are prescribed.
Is there a reasonable medical probability your patient will experience side effects from the
medication(s) listed above?
Yes
No
Other:
To what degree will the side effects of the prescribed medications impair your patient’s ability
for concentration, persistence and pace in combination with the underlying condition(s)?
Mental Functional Assessment – Page Number 7
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