Get F00098 2016-2025

Filling out the F00098 form is crucial for the assessment of wheelchair, scooter, or stroller seating needs. This guide provides step-by-step instructions to help users complete the form accurately and effectively.

Follow the steps to complete your F00098 form online.

1. Press the ‘Get Form’ button to access the F00098 form and open it in the editing interface.
2. Begin by filling out the 'Client Information' section, including the first name, last name, Medicaid number, date of birth, diagnosis, height, and weight of the client being assessed.
3. Move to Section I, titled 'Neurological Factors.' Indicate and describe the client's muscle tone, active movements affected, passive movements affected, and reflexes present.
4. In Section II, 'Postural Control,' evaluate and record the client’s head control, trunk control, and upper and lower extremities.
5. Proceed to Section III, 'Medical/Surgical History and Plans.' Answer questions regarding decubitis/skin breakdown, orthopedic conditions, physical limitations, and any anticipated surgical procedures.
6. Complete Section IV, 'Functional Assessment,' by indicating the client's ambulatory status and wheelchair ambulation status, including transfer capabilities and feeding needs.
7. In Section V, 'Environmental Assessment,' describe the client's living and schooling environments, accessibility features, and related equipment.
8. Fill out Section VI, 'Requested Equipment,' detailing the current seating system, why it does not meet the client's needs, and the medical necessity for requested equipment.
9. Sign and date Section VII, ensuring both the therapist/physician and the Qualified Rehabilitation Professional (QRP) provide their signatures and contact information.
10. If applicable, complete Section VIII for power wheelchairs, justifying the need for power versus manual options.
11. Conclude with Section IX by having the therapist/physician and QRP provide their signatures along with additional necessary details.
12. Finally, save your changes. You may choose to download, print, or share the completed form as necessary.

Start completing your F00098 form online today.