Sample Residual Functional Capacity Forms (RFC Forms)

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Robin Mead

The Residual Capacity Function Form is a form you can bring to your doctor to help document your level of disability and functioning.

BEFORE YOU START

There are a few important things you need to know before requesting an RFC form from your doctor. Please read: How to Get a Great RFC Function Form

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

SAMPLE FORMS

Below are different versions of RFC forms created by disability lawyers and advocates. Choose the version that works best by you. The Social Security Administration also has it’s own version of RFC forms. However, most disability lawyers do not use the Social Security Administration version because it leaves out some critical questions that can be key to winning your case.

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.

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 PHYSICAL FORM?

It is most helpful if this form is filled out by an MD or a DO or another doctor who is an acceptable medical source. In the ideal world, it is great to get more than one form filled out by more than one practitioner.

WHO SHOULD FILL OUT THE MENTAL FORM?

If you have been diagnosed with serious mental illness, it is best if the mental form is filled out or co-signed by a licensed psychiatrist or psychologist. You can also get a second mental form from a therapist, counselor, Social Worker, or other doctor.

If you have not been diagnosed with serious mental illness, the mental form can be filled out by your primary care doctor, or any doctor who is aware of your mental limitations.

HOW SHOULD I SUBMIT MY FORMS?

We have recently got many reports from readers who have had bad experiences trying to submit important important documents to their local Social Security office. These documents were either refused, rejected, lost, misfiled, or mysteriously never got reviewed by the person making the decision. You may wish to avoid your local office and work directly with the person or office who will be handling the decision on your case. Learn more about How to Submit

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 Doctor Letters

Updated Aug 2018. Please comment below with stories, questions, input or ideas. Please let us know if any links on this page stop working. If you found this page helpful, please use one of these magic buttons to share this post on Facebook or Twitter:

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

  1. 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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