Get D1316 Recliner Chair Assessment Form (pdf 220 Kb) - Dva Gov

The D1316 Recliner Chair Assessment Form is a vital tool for assessing the needs of individuals requiring a recliner chair due to mobility or medical issues. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the D1316 Recliner Chair Assessment Form.

1. Click the ‘Get Form’ button to obtain the assessment form and open it in your preferred PDF editor.
2. Begin by filling in the provider details section, which includes fields for the provider's name, provider number, employer, address, and contact information such as phone, fax, and email.
3. In the entitled person or delivery details section, provide the relevant personal information including surname, given names, date of birth, DVA file number, card type, and whether the individual resides in a residential aged care facility.
4. Indicate the current home care package level and provide a contact number for the entitled person. Ensure that all required fields are completed accurately to avoid processing delays.
5. Document the clinical justification for the recliner chair. Specify any medical conditions that affect the individual's ability to transfer safely to and from standard seating.
6. Fill out the diagnosis and medical history section. If applicable, specify the period post-surgery or hospital admission and indicate if the person is under palliative care.
7. If the physiotherapist is not the prescriber, complete the physiotherapy plan section with the provider’s details and communication summary.
8. Conduct a clinical and functional assessment by providing details about current seating and transfer skills, including chair conditions and the ability to transfer safely.
9. Record the entitled person's weight and seated anthropometric measurements, as these are important for recommending the correct chair size.
10. Assess the individual's ability to operate the recliner chair and confirm whether there is a power source available within reach for electric models.
11. Finally, certify the assessment by signing and dating the form, ensuring to review all information filled in beforehand.
12. Once all sections are completed, you may save the document, download it for submission, print a copy for your records, or share it with relevant parties.

Complete your D1316 Recliner Chair Assessment Form online today to ensure timely processing of your assessment.