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  • Wheelchair Assessment Order Form

Get Wheelchair Assessment Order Form

Wheelchair Assessment Order Form Please fax to SelfCare Vancouver 604.872.8388 or North Shore 604.990.9424 or Surrey 604.574.5805.

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Qualifying Diagnoses for Wheelchairs Multiple Sclerosis (MS) ALS (AKA Lou Gehrig's Disease) Parkinson's Disease. Spinal Cord Injuries. Cerebral Palsy. Muscular Dystrophy. CVA (AKA stroke-related paralysis) Post-Polio Syndrome.

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.

What happens at the assessment? The clinician will introduce themselves and explain what will happen. They will need to ask you many questions and take your measurements. They may need to assess your range of movements and physical constraints, and may ask you to demonstrate your abilities.

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 happens at the assessment? The clinician will introduce themselves and explain what will happen. They will need to ask you many questions and take your measurements. They may need to assess your range of movements and physical constraints, and may ask you to demonstrate your abilities.

Wheelchair Mobility Assessment ICD-10-PCS F01ZFZZ is a specific/billable code that can be used to indicate a procedure.

In the Guidelines, WHO outline the following eight steps that wheelchair service personnel need to carry out to provide an appropriate wheelchair....Introduction Referral and Appointment; Assessment; Prescription; Funding and Ordering; Product Preparation; Fitting; User Training; Maintenance, Repairs and Follow-Up.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232