Get Standing Frame Evaluation Form - Louisiana Medicaid

Filling out the Standing Frame Evaluation Form for Louisiana Medicaid ensures that users receive the necessary equipment for their mobility needs. This guide provides a step-by-step approach, making the process clear and manageable for all professionals involved.

Follow the steps to complete the Standing Frame Evaluation Form online.

1. Click ‘Get Form’ button to download the Standing Frame Evaluation Form for completing the necessary information.
2. In the 'General Information' section, provide the recipient's details, including their name, date of birth, and address. Make sure to include the Medicaid ID number and any other insurance information.
3. Proceed to 'Medical History' where the physician should detail the recipient's diagnosis, age at diagnosis, prognosis, and any recent changes in medical status.
4. In the 'Present Standing Frame' section, indicate whether the recipient currently owns a standing frame. If so, record the frame’s serial number, model, age, and evaluate if it can be repaired.
5. Complete the 'Home Environment' section by noting the living arrangement of the recipient and whether their home can accommodate a standing frame.
6. Fill in the 'Cognition' section, assessing various cognitive skills such as memory and problem-solving abilities.
7. Next, move to the 'Communication', 'Sensation', 'Pathological Reflexes', and 'Mobility' sections, checking the required boxes and providing additional comments where necessary.
8. In the 'Standing Frame Program/Trial & Considerations' section, detail the alternatives considered, recipient's willingness to use the standing frame, and caregiver support.
9. Complete assessments in the 'Posture', 'Upper Extremity', 'Lower Extremity', 'Balance', and 'Pain and Edema' sections, providing thorough evaluations and scores as needed.
10. Finish with the 'Seating Measurements' and 'Recommended Standing Frame' sections. Justify the recommended size and any non-standard parts required.
11. Ensure all sections are signed by the involved professionals. Initial each section and add appropriate signatures.
12. Once finalized, users can save changes and download, print, or share the completed form as needed.

Start filling out the Standing Frame Evaluation Form online to ensure timely processing of your request.