Functional Assessment Physical Abilities

Use to evaluate a patient’s ability prior to return to work. Enter in the Screening Folder, Job Search section. The form is available in two formats: a concise single page without explanations, and a comprehensive two page list of all the ratings with explanations.

A sample portion of the Functional Assessment Physical Abilities form is displayed below. A printable PDF version is available in the Copy-ready Forms packet from the Customer Resource Center: http://ul.custhelp.com (login required).