Get Al Form 384 2017-2025

Filling out the AL Form 384 online can streamline the process of obtaining the necessary wheelchair or seating evaluation for Medicaid coverage. This guide will walk you through each section of the form, providing clear instructions to ensure that all required information is properly submitted.

Follow the steps to complete the AL Form 384 online efficiently.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient's name at the top of the form, followed by essential details such as today's date and the start and end times of the evaluation.
3. In the referral information section, indicate if the patient is receiving any services and provide details for the referring physician, including their contact information.
4. Fill out the patient information, including age, date of birth, and details about the person accompanying the patient. This section may also include any relevant medical history.
5. Next, document the current wheelchair or seating system being used, including manufacturer details and measurements. Mention any problems experienced with the current system.
6. Provide information about the home environment, detailing accessibility issues and living arrangements.
7. Complete the caretaker section, specifying the primary caregiver and if the patient spends time alone at home.
8. Document transportation details, including whether the patient drives and the type of vehicle used for transport.
9. Fill out the communication and pain sections, as well as skin condition and integrity details, making sure to check all relevant boxes.
10. Assess daily living activities, current mobility status, and any functional reach measurements to provide a comprehensive overview.
11. Complete the recommendations section, specifying the equipment needed along with justifications for each item.
12. Review all entered information for accuracy. Save changes, download a copy of the form, or print it for submission as needed.

Ensure a smoother evaluation process by filling out the AL Form 384 online today.