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PHYSICAL MEDICAL SOURCE STATEMENT From: Re: (Name of Patient) (Social Security No.) Please answer the following questions concerning your patient's impairments. Attach relevant treatment notes, radiologist

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What is physical medical source statement?

Physical medical source statement is a form completed by a medical professional that provides detailed information about an individual's physical limitations and abilities.

Who is required to file physical medical source statement?

Physical medical source statement must be completed by a licensed medical professional who has treated or evaluated the individual.

How to fill out physical medical source statement?

To fill out a physical medical source statement, the medical professional must assess the individual's medical history, symptoms, and functional limitations, and provide detailed information about their physical abilities.

What is the purpose of physical medical source statement?

The purpose of a physical medical source statement is to assist in evaluating an individual's ability to perform work-related tasks and to determine their eligibility for disability benefits.

What information must be reported on physical medical source statement?

A physical medical source statement must include information about the individual's medical history, diagnosis, treatment, symptoms, and functional limitations, as well as the medical professional's opinion on the individual's ability to perform work-related tasks.

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