Get D9160 Request For Exercise Bike - Department Of Veterans' Affairs - Dva Gov

The D9160 Request For Exercise Bike form is essential for initiating the process of acquiring an exercise bike through the Department Of Veterans' Affairs. This guide will provide you with clear, step-by-step instructions to ensure a smooth online completion of the form and enhance your experience.

Follow the steps to accurately complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the appropriate online editor.
2. Enter the client's name in the designated field to identify the individual requesting the exercise bike.
3. Provide the file number, which helps in referencing the client’s records and progress.
4. List current clinical issues to justify the need for an exercise bike, ensuring to detail how these issues will be addressed by its use.
5. Outline functional goals and baseline outcome measures that will gauge the effectiveness of using the exercise bike, specifically including the Lower Extremity Functional Scale Score.
6. Explain why the client cannot achieve similar benefits from other forms of exercise, providing thorough reasoning for the necessity of an exercise bike.
7. Indicate whether the client is continuing with physiotherapy treatment by selecting 'Yes' or 'No'.
8. State whether you have supervised the client on an exercise bike. If 'Yes', outline the ongoing physiotherapy treatment plan.
9. Assess safety issues by answering questions concerning the client’s ability to mount the bike, risk of skin tears, and their reliability in monitoring exertion level during exercise.
10. Attach a medical certificate from the client’s medical officer or specialist, confirming it is safe for the client to use an exercise bike as part of their exercise program.
11. Provide the physiotherapist's name and contact details, including their address, telephone number, fax number, and email address.
12. Sign and date the form to finalize the submission. Ensure all necessary attachments are included.
13. Upon completion, save your changes and choose to download, print, or share the form as needed.

Complete the D9160 Request For Exercise Bike form online to enhance your access to necessary equipment.