Residual Functional Capacity Substance Addiction Related Mental Disorder Page 7

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Mild
Moderate
Marked
Severe
No
Impairment
Impairment
Impairment
Impairment
Impairment
Understand and remember detailed
instructions,
Carry out detailed instructions
Set realistic goals or make plans
independently of others.
Signature of Physician___________________________________ Date __________________
Page 7 of 7

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