Ohio county agencies use this assessment with the JFS 07302 Basic Medical when a Disability Financial Assistance applicant has a mental impairment. The clinician rates 20 work-related abilities in four groups (understanding and memory, sustained concentration and persistence, social interaction, adaptation) and answers the same nine-month disability question used on the Basic Medical.
A primary care physician, psychiatrist or licensed psychologist completes Section II and signs the certification with date of last exam and specialty. The county caseworker completes Section I.
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Mental Functional Capacity Assessment
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The signature line is for a physician, psychiatrist or licensed psychologist, and the form asks whether the signer is the client's primary care physician, psychiatrist or licensed psychologist. The signer certifies under penalty of law that the information is true and accurate.
Each of the 20 abilities is checked as not significantly limited, moderately limited, markedly limited, or not rated. The abilities fall under understanding and memory, sustained concentration and persistence, social interaction, and adaptation.
When a mental impairment is involved, yes. The Basic Medical (JFS 07302) covers exam findings, diagnoses and physical capacity, and its findings section asks for the separate mental impairment form as appropriate. JFS 07308 then documents the mental functional limits used in the DFA disability decision.