Category III - Pain/Other Symptoms/Impairment Information

Disability Case Development Information Collections

OMB: 0960-0555

IC ID: 181780

Documents and Forms

Document Name Document Type
Form Pain Questionnaire Category III - Pain/Other Symptoms/Impairment Information Form
Form Pain Questionnaire Category III - Pain/Other Symptoms/Impairment Information Form
Pain Questionnaire Pain Questionnaire Category III - Pain, Other Symptoms, Impairment Information - Revised.pdf Form
Muscle Examination CE - Muscle Examination.pdf Form
CE - Arterial Doppler Evaluation With Toe.pdf Other-CE- Arterial Doopler Evaluation With Toe
CE - Fibromyalgia Evaluation Sheet.pdf Other-CE-Fibromyalgia Evaluation Sheet
CE - Range of Motion Chart.pdf Other-CE_ Range of Motion Chart
CE - Resting Doppler Evaluation.pdf Other-CE- Resting Doopler Evaluation
Third Party Request with Seizure Witness Questionnaire.pdf Other-Third Party Request with Seizure Witness Questionnaire
Category III - Pain, Other Symptoms, Impairment Information - Current.pdf Category III - Pain, Other Symptoms, Impairment Information - Current IC Document