Physical Residual Functional Capacity Questionnaire

Client/Agency Forms

This questionnaire, provided by attorney Leslie Kline-Capelle, formerly of Health Advocates, is intended to assist with a determination of disability for purposes of obtaining social security disability benefits. In order to be effective, the form must be completed by a medical doctor who is treating the individual applying for benefits. Although not HIV/AIDS specific, the form, if properly completed, may be a helpful piece of evidence in a case being heard by an administrative law judge (ALJ).