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Psychiatric Impairment

Page One

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1. Ability to comprehend and follow instructions
How has your function been affected in these areas. Document with specific examples.
2. Ability to perform simple and repetitive tasks
How has your function been affected in these areas. Document with specific examples.
3. Ability to maintain a work pace appropriate to a given work load
How has your function been affected in these areas. Document with specific examples.
4. Ability to perform complex and varied tasks
How has your function been affected in these areas. Document with specific examples.
5. Ability to relate to other people beyond giving and receiving instructions
How has your function been affected in these areas. Document with specific examples.
6. Ability to influence people
How has your function been affected in these areas. Document with specific examples.
7. Ability to make generalizations, evaluations or decisions without immediate supervision
How has your function been affected in these areas. Document with specific examples.
8. Ability to accept and carry out responsibility for direction, control and planning
How has your function been affected in these areas. Document with specific examples.