Wheelchair/Scooter/Stroller Seating Assessment Form (THSteps-CCP/Home Health Services) (Next 6 pages) Instructions A current wheelchair seating assessment conducted by a physician, physical or occupational.
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How to fill out the Wheelchair Seating Evaluation Form online
The Wheelchair Seating Evaluation Form is a crucial document used to assess the specific needs of a person who uses a wheelchair. Filling out this form accurately helps in determining the right seating solutions required for comfort and medical necessity. This guide aims to provide clear, step-by-step instructions for completing the form online.
Follow the steps to successfully complete the form online.
- Press the ‘Get Form’ button to retrieve the Wheelchair Seating Evaluation Form and access it in your preferred online format.
- Begin by filling out the Client Information section, which includes critical details such as the first name, last name, Medicaid number, date of birth, diagnosis, height, and weight of the client.
- Proceed to Section I: Neurological Factors, and indicate the client's muscle tone. Select from options like hypertonic, absent, or fluctuating, and provide descriptive responses regarding active and passive movements affected by muscle tone.
- Move to Section II: Postural Control. Here, evaluate the client’s head, trunk, upper extremities, and lower extremities, marking their control level from good to none.
- In Section III: Medical/Surgical History and Plans, detail any history of skin breakdown, orthopedic conditions, and recent medical changes, including anticipated surgeries.
- Next, in Section IV: Functional Assessment, indicate the client’s ambulation potential and transfer capabilities. Provide information regarding dependence on the wheelchair and any assistance required during dressing or feeding.
- Continue to Section V: Environmental Assessment, describing the client's home and educational settings, and assessing their accessibility for wheelchair use. Note if ramps are available in both settings.
- For Section VI: Requested Equipment, outline the client’s current seating system, why it’s inadequate, and detail the requested equipment along with the associated medical necessity.
- If applicable, complete Section VII for power wheelchairs, justifying the need for a power versus manual wheelchair and assessing the client's ability to operate it.
- Conclude by ensuring all required signatures from the physician or therapist are included, as well as their contact information. Once all sections are complete, save your changes, and download or print the form as needed.
Complete your Wheelchair Seating Evaluation Form online today to ensure the proper seating solution is obtained for your needs.
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What to expect at a wheelchair evaluation?
In most cases the physical assessment will also include a full musculoskeletal examination of the users range of motion, joint flexibility, muscle length, and skeletal alignment, with neurological issues such as tone and spasm pattern also noted as they affect posture and muscle length.
What needs to be included in the evaluation of a wheelchair for an individual?
Wheelchair Evaluation Seat width, depth, and height. Patient hip, trunk, and shoulder widths. Patient shoulder and axillae heights. WC Leg length, arm height, back height. WC width, height, and size. Knee-to-seat depth. Knee-to-heel length. Seat-to-back support angle.
How do you get evaluated for a wheelchair?
Typically the clinician is an Occupational Therapist (OT) or Physical Therapist (PT), so the prescription from your doctor will read, "OT or PT Wheelchair Evaluation." Getting a prescription from your doctor is essential, because it allows a therapist (OT or PT) to conduct an evaluation.
What should be included in a mat evaluation for wheelchair seating?
Here are the key components of a mat exam that we need to include. Muscle Tone. Muscle Strength. Range of Motion. Reflexes. Movement patterns. Postural Control.
What happens after a wheelchair assessment?
What happens after I've been assessed? If, after your assessment, it has been determined that you need a wheelchair, we will supply and set up the mobility equipment, including any cushions or accessories that you may require.
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