Get Functional Mobility & Wheelchair Assessment

Completing the Functional Mobility & Wheelchair Assessment online is an important step in evaluating a person's mobility needs and ensuring they receive the appropriate equipment. This guide will provide clear, step-by-step instructions to help you navigate and fill out the form effectively.

Follow the steps to complete your assessment online.

1. Press the ‘Get Form’ button to access the assessment form and open it in your preferred document platform.
2. Begin by entering the patient information in the designated fields, including their name, date of birth, address, physician details, and contact information for caregivers. Ensure accuracy when entering this critical data.
3. Next, complete the medical history section. Document the patient’s diagnoses, any relevant surgeries, and provide notes on their height and weight. Be descriptive about recent changes or trends in their weight if applicable.
4. Proceed to the mobility and balance section. Indicate the patient's sitting and standing balance, transfers, and ambulation abilities. Be sure to check relevant boxes and provide detailed comments as required.
5. Fill out the current seating and mobility details, including the type and condition of the mobility device used. This section helps to determine if the current equipment meets medical necessity.
6. Address the community and transportation options, specifying how the mobility device is used in everyday situations. Mention storage options and any modifications needed for safe transport.
7. Complete the sections on communication, sensation and skin issues. Use the options provided to ensure comprehensive coverage of the patient’s needs.
8. If applicable, make comments regarding the use of augmentative communication devices or other supports that affect the patient's mobility.
9. Once all sections are completed, review the entered information for accuracy. Save your changes to ensure nothing is lost.
10. Finally, download, print, or share the completed form as necessary for your records or to submit it to healthcare providers.

Take the next step to streamline your evaluation process by filling out the Functional Mobility & Wheelchair Assessment online.