Residual Functional Capacity Ssa Listed Disorders Page 5

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____ Elevation to waist level
____ Elevation to only six inches or less
F) TOTAL CUMULATIVE sitting during an 8 hour work day, NOT INCLUDING time
spent standing or walking about. (Circle one please)
<1 hr 1 hr 2 hrs 3 hrs 4 hrs 5 hrs 6 hrs >6 hrs
12. STANDING AND WALKING ABOUT: weight bearing ambulating.
A) maximum continuously STANDING OR WALKING ABOUT before alternating
postures sitting or lying down. (Circle one please)
Less than15 min --15 min --- 1 hr --- 2 hrs --- 3 hrs --- less than 3 hrs
B) After standing or walking about for the maximum continuous period, does
this patient need to ALTERNATE POSTURES by sitting lying down or reclining in
a supine positions?
____ YES, by lying down or reclining in a supine position.
____ YES, but sitting in a working position at a desk or table is sufficient.
___ NO, alternating postures is not medically indicated.
C) If so, HOW LONG does the patient need to sit or lie down/recline before
returning to standing or walking about for another maximum continuous interval?
(Circle one please)
Less than15 min --15 min --- 1 hr --- 2 hrs --- 3 hrs --- less than 3 hrs
D) TOTAL CUMULATIVE standing or walking about during an 8-hour work day NOT
INCLUDING time spent sitting or lying down/reclining. (Circle one please)
Less than 1 hr --- 1 hr --- 2 hrs --- 3 hrs --- 4 hrs --- 5 hrs --- 6 hrs --- Less than 6
hrs
13. RESTING lying down or reclining in a supine position in bed or in an easy
chair.
A) Does this patient need to REST for some period of time during an eight hour
work day? (Circle one please)
_____ YES, in addition to a morning break, a lunch period, and an afternoon
break scheduled at approximately two hour intervals, more rest is needed.

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