Sample Residual Functional Capacity Forms (RFC Forms)

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Art: Robin Mead

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RFC FORMS

The Residual Capacity Function Form is a form you can bring to your doctor to help document your level of disability and functioning. Below are a wide assortment of forms you can print and bring to your doctor. Please comment below to let us know if any links to forms stop working.

BEFORE YOU START

Forms from your doctor can help your case (a lot!). Or they can hurt your case (a lot!).  Or they can be dismissed or ignored (sad but true). Before asking your doc for a form, take a look here: How to Get a Great RFC Function Form

HAVING DOCTOR PROBLEMS?

If your doctor won’t fill out disability paperwork, don’t give up hope: How To Get Your Doctor to Fill Out Paperwork

WHICH FORMS TO USE? 

There are many forms included below, but you do not need to use them all. Most people use just the first two forms: physical and mental. Some people use just one: physical or mental. If you have not been diagnosed with mental illness, the mental form can still be helpful if you experience any problems with memory, focus, or concentration (because of pain, fatigue, medication side effects, neurological problems, etc).

WHO SHOULD FILL OUT THE FORM?

Physical disabilities: It is most helpful to have at least one form filled out by an MD or a DO or another doctor who is an acceptable medical source. You can also collect more than one form from more than one practitioner.

Mental health: It is most helpful to have a form filled out by a licensed psychologist or psychologist. If this is not possible, then a form from an MD or another doctor who is an acceptable medical source. You can also collect additional forms from therapists, counselors, Social Workers, etc.

PHYSICAL RFC FORMS 

MENTAL RFC FORMS

PAIN FORMS

ENVIRONMENTAL LIMITATIONS FORM

CHRONIC FATIGUE SYNDROME FORMS

FIBROMYALGIA FORMS

THYROID FORMS

SLEEP DISORDERS

HEADACHES

DIZZINESS

SPINE DISORDERS

ADDITIONAL CONDITIONS

List of RFC Forms for Other Conditions – From disability attorney Mike Murberg in Florida.

List of RFC Forms for Other Conditions – Click on “Medical Provider Evaluation Forms”.

Important

Your perfect, amazing RFC Form will not help you if the person making the decision at Social Security never reads it. It is tragically common for records to be lost, misplaced, or put in the wrong person’s file. How to Submit Records So They Go to the Right Person in the Right Place

Even if you have a lawyer, your important records can go missing from your file. This has happened to many of our readers. How to Tell What is (and isn’t) in Your Social Security File

SUCCESS STORIES

How Violet Got Great Function Forms

Laurel Gets Two Great Letters and Two Great Forms

SAMPLES

Sample cover letter (optional)

Sample completed RFC form

Sample Disability Letters from Doctors

LEARN MORE

💮 This page is part of the free online guide: The Sleepy Girl Guide to Social Security Disability 

💮 Learn more about this topic here: How to Work with Your Doctor to Get Great Disability Documentation

💮  Art on this page by Robin Mead and Elizabeth D’Angelo.

💮  Page Updated: 7/1/19

💮  Please comment below with stories, ideas, questions or suggestions. Please let us know if any links on this page stop working.

💮  If you found this page helpful, please share it with others by pressing one of these magic little buttons:

23 thoughts on “Sample Residual Functional Capacity Forms (RFC Forms)”

  1. Arthritis form not opening. I am overwhelmed with what forms are best for me.
    I have bipolar, anxiety, depression, mood swings, back, shoulder, legs, neck pain cannot stand too long or walk long, arthritis in lower back, legs pain when sleeping, I avoid going anywhere. Can you suggest forms for me?

    Like

  2. My question is about attorney fees if allowed. I know the 25 percentage allowed but what about copying, postage, telephone calls, travel, and other expenses estimated at $125 . At attorney discretion there be additional charges for obtaining copies of medical records or other records, expert opinions or evaluation and out of town travel.
    I should be allowed to get records of mine and travel right now doing phone hearings only told.

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  3. Is there an updated list of doctors? that is the hardest part is the doctors neurologists, GI, ME testing, Cognitive testing providers? Florida Area?

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  4. my husband has a fuzed spine and got a short form recently, he hasn’t been to the doctor in years bc all they wanted to do was put him on pain pills, which he became addicted to, he got off all pain pills three years ago and hsn’t been to doctor since. He hurts everyday though and uses heat pads and IBU. How do i tell them on short form he hasn’t been to the doctor.

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    1. Exactly the way you just did. You should still list the older medical sources (name and address) so they can see it and read it for themselves. Also if he has not seen a doctor in the last 12 months he will need to agree to go to an exam by SSA.

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  5. **urgently need some help please*
    Hey! I have read several stories about a user here who was able to put together a short RFC form for doctor appointments. Is there any way you can see if they still have it? I am needing one to use for my appointments as i’m about to lose insurance. i do have a long one but i wanna get as many as i can so that’d help a ton. or if you guys can suggest what to put on a shorter one to use at every doctor appointment? i’m really not well right now and struggling to put my case together by myself (no family/friends/social worker/lawyer). i have other conditions too but ME since 12. thank you

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  6. Please help! My husband has EDS hyper mobile and is in chronic pain. Not a day goes by he is in horrible pain. Sometimes his back (which he needs surgery), his hip (needs total hip replacement), and shoulder ( needs surgery). Chronic hip subluxations, rib dislocations, and the three bulging discs in his lower back compressing on a nerve do not help matters. Necrosis in the hip is a ticking time bomb. We have sold our house and living on one income and before being extremely desperate I need to know if there is any hope in refining a claim that has been denied by a disability judge. If so, how?! Please and thank you:)

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  7. I receive disability benefits each month and I have forms for my doctor to fill out. SURS Disabilty from the State University Retirement System and from Met Life and I need them filled out I have a week in a half to send them in to continue to receive my benefits. I was told by my primary doctor that he doesn’t fill out paperwork. Time is not on my side now because they have to be sent in before the 20th….I may lose my apartment if I don’t have rent. I need to know what I can do.

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    1. Do you have any other doctors you can ask?

      If not, I would set up an appointment with the doctor in person. Don’t tell the front desk what the appointment is for.

      Explain the situation in person to the doctor and beg him to do it for you this one time. Let him know it is a one time favor. Mention it first thing so he has time to do it during the appointment.

      Before the appointment, try to put together any information you can that will save your doctor time and make it easier for him to fill out the form quickly during the appointment.

      After that, you may need to find another doctor willing to fill out forms before next time.

      Hope it works!

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  9. Since we know that my Doc isn’t going to fill in three separate forms and I have herniations in all three sections of my back, do you have any recommendations or insights into which form I might use? I just found this site, beautiful job!

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    1. Good question. I don’t have a specific recommendation. I would just look through and see which you find best suited. When in doubt, you can always do a Physical RFC form – it works for any condition.

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    1. Thank you. I’m sorry for the slow response. It looks like they are opening but they are docx. You might try creating a google drive account and opening them in google docs. If you already have gmail, I believe you should already have an google drive.

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  11. This web site has proven to be the most valuable information i have received. This like the holy grail to disability, Thank you for all your hard work. I have no idea how you were able to put together such amazing guide with any disability but kudos to you.

    Liked by 1 person

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