Get Wheelchair Scooter Stroller Seating Assessment Form

Filling out the Wheelchair Scooter Stroller Seating Assessment Form online is a straightforward process that ensures you provide all necessary information for effective assessment. This guide will walk you through each section, detailing the information required for a comprehensive assessment.

Follow the steps to successfully complete the assessment form.

1. Press the ‘Get Form’ button to obtain the assessment form and open it in your preferred editor.
2. Begin with the Client Information section. Input the client's first and last name, Medicaid number, diagnosis, height, weight, and date of birth accurately as this information is critical for the assessment.
3. In Section I (Neurological Factors), provide details regarding the client’s muscle tone, active and passive movements, and reflexes. Be descriptive and accurate to ensure a valid assessment.
4. Next, move to Section II (Postural Control). Indicate the client's head and trunk control along with upper and lower extremity control levels. Use the provided options to make selection easy.
5. For Section III (Medical/Surgical History and Plans), answer whether there is a history of skin breakdown, describe orthopedic conditions, and note any expected changes in medical status.
6. Section IV (Functional Assessment) focuses on the client’s ambulatory status. Clearly indicate mobility potential and transfer capabilities, and provide explanations where applicable. Describe any daily activities performed while in a wheelchair.
7. In Section V (Environmental Assessment), describe the client's living and educational environments. Mention if they are wheelchair accessible and list available ramps.
8. Section VI (Requested Equipment) requires information about the current seating system and why it does not meet the client’s needs. Describe the requested equipment and the medical necessity behind it.
9. For Section VII (Signatures), ensure that the required professional signatures and details from the physician or therapist are added, along with their contact information.
10. If applicable, complete Section VIII (Power Wheelchairs) by providing information about medical necessity and control mechanisms for the power wheelchair. Responses to questions must be thorough.
11. Finally, review all sections for completeness. Once satisfied with the entries, save the changes.
12. You can choose to download, print, or share the completed form as necessary.

Start filling out the Wheelchair Scooter Stroller Seating Assessment Form online to ensure comprehensive assessment and appropriate equipment procurement.