| 45965-1 | Name:-:Pt:^Patient:Set: | |
| 45396-9 | Social Security # | |
| 46638-3 | IP CDB claim numberholder:ID:Pt:^Patient:Nom:RFC assessment | |
| 46639-1 | Diagnosis.primary:Imp:Pt:^Patient:Nar:RFC assessment | |
| 46640-9 | Secondary diagnosis:Imp:Pt:^Patient:Nar:RFC assessment | |
| 46641-7 | Other alleged impairments:Imp:Pt:^Patient:Nar:RFC assessment | |
| 46642-5 | Limitations section:-:Pt:^Patient:Set:RFC assessment | |
| 46691-2 | Symptoms:Find:Pt:^Patient:Nar:RFC assessment | |
| 46692-0 | Treatment or examining source statements:-:Pt:^Patient:Set:RFC assessment | |
| 46696-1 | Additional comments:Imp:Pt:^Patient:Nar:RFC assessment | |
| 46637-5 | Residual physical functional capacity (RFC) assessment form:-:Pt:^Patient:-:RFC assessment | |