Residual Functional Capacity Ssa Listed Disorders Page 8
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13B) Handling (i.e. seizing, grasping, turning or otherwise working primarily
with the whole hand)
RIGHT HAND
Never
Occasionally
Frequently
Constantly
No
Not Able to Assess
LEFT HAND
Never
Occasionally
Frequently
Constantly
No
Not Able to Assess
C) Fingering (i.e. picking, pinching or otherwise working primarily with the fingers)
RIGHT HAND
Never
Occasionally
Frequently
Constantly
No
Not Able to Assess
LEFT HAND
Never
Occasionally
Frequently
Constantly
No
Not Able to Assess
Please check the frequency with which the patient can perform the following activities:
Rarely – 0-30%
Consistently – 70-100%
Never
Frequently- 30-70%
Percentage of Time
Reach Up Above
Shoulders
Reach Down to Waist
Level
Reach Down Towards
Floor
Carefully Handle Objects
Handle with Fingers
Assistive Devices Required for Ambulating
A) Is a hand held assistive device medically required to aid the patient in walking or
standing?
____ YES, to aid in BOTH walking and standing
____ YES, to aid in ONLY walking, not standing
____ NO
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Parent category: Medical