Parkinson's Disease Work-Related Disability Assessment Form

PAN has learned that some people with Parkinson's may have trouble receiving SSDI or SSI benefits due to inadequate documentation of symptoms in their medical record. PAN has developed the Parkinson’s Disease Work-Related Disability Assessment Form to assist with this issue.

The purpose of the form is to ensure that information that may be relevant to how Parkinson's disease affects your ability to work is included in your medical record, particularly if you think you may apply for SSDI or SSI. This form may also be useful in tracking your disease progression and can be updated as your condition and symptoms change.   

It is important to note that this form is designed to supplement your medical record. It is not an official SSA form and does not replace or change the Social Security application.

Download the Form.

This form was created with generous support from Solvay Pharmaceuticals, Inc., now part of Abbvie.

PAN, together with the other national Parkinson’s organizations, asks for your help in distributing this form. Distributing the form to people living with Parkinson’s, caregivers/carepartners, doctors, support groups, and online communities is essential in assuring that the form makes it into the hands of patients and doctors and ultimately into medical records. The form can be downloaded, printed, posted on bulletin boards, discussed with doctors or support groups, and posted on-line. It is free for all to use.
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