PD Work-Related Disability Assessment Form

Release date: 6/11/2010

The Parkinson's Action Network (PAN), in collaboration with other Parkinson's organizations including NPF, is pleased to announce the Parkinson's Disease Work-Related Disability Assessment Form.


People with Parkinson's may experience trouble seeking Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits due to inadequate documentation of symptoms in their medical record. This form may be helpful to Social Security reviewers during the SSDI/SSI application process. It was created with the hope that it will be used by both clinicians and patients as a way to document and track a person's symptoms with particular focus on the symptoms that are most likely to interfere with one's ability to work.

The Parkinson's Disease Work-Related Disability Assessment form is designed to supplement a patient's medical record and is not a Social Security Administration form or application.

This form can be downloaded, printed, posted on bulletin boards, discussed with doctors or support groups, and posted on-line.  Visit the PAN website to download the form.

Learn more about Social Security Basics on Parkinson.org.