Fillable functional capacity form

Description of functional capacity certificate form
Functional Capacity Certificate Form 507 FCC507 NOTE TO BE COMPLETED BY SERVICE MEMBER PLEASE READ QUESTIONS CAREFULLY Answer All Questions by placing an X in the appropriate block. If No Current Physical Limitations indicate None. 2. Physician s Statement I have reviewed this Service Member s Functional Capacity Certificate FCC507 and Circle One CONCUR / DO-NOT-CONCUR with Service Member s Self Assessment....
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