Get the free Seating and Mobility Referral - bshepherdorgb

2020 Peach tree Road NW Atlanta, GA 303091465 4043522020 shepherd.org Seating and Mobility Referral Name Date of Birth Address City State Zip Home Phone Cell Phone Email PT or OT Evaluation for Seating

How to fill out seating and mobility referral

How to fill out seating and mobility referral:

1. Begin by gathering all relevant medical information and documentation, such as the patient's diagnosis, prognosis, and any previous evaluations or assessments related to their seating and mobility needs.
2. Fill out the referring healthcare professional's information section, including their name, contact information, and any necessary credentials or affiliations.
3. Provide the patient's personal information, including their name, date of birth, address, and insurance details.
4. Describe the patient's current functional abilities and limitations, specifically focusing on their mobility and seating needs. Include information about their ability to transfer, walk, or use assistive devices.
5. Specify the reason for the referral, highlighting any specific concerns or goals related to the patient's seating and mobility. This could include factors such as pain, pressure sores, positioning difficulties, or impairment in daily activities.
6. Indicate any previous interventions or equipment tried, including the types of wheelchairs, cushions, or supports that have been utilized in the past. Explain the effectiveness or limitations of these interventions.
7. Provide any additional relevant information or requests, such as the need for specialized seating or positioning options, alterations to equipment, or specific accessories required.
8. Review the completed referral form for accuracy and completeness before submitting it to the appropriate healthcare professional or organization.

Who needs seating and mobility referral:

1. Individuals with physical disabilities or limitations that affect their mobility and seating requirements may require a seating and mobility referral. This can include individuals with spinal cord injuries, neuromuscular disorders, stroke, cerebral palsy, multiple sclerosis, or amputations.
2. Those experiencing significant difficulty with activities of daily living due to their mobility challenges may also benefit from a seating and mobility referral. This includes individuals who struggle with transferring, walking, or maintaining proper posture and positioning.
3. People who require assistance with pressure relief, prevention of pressure sores, or management of chronic pain may also be candidates for a seating and mobility referral.
4. Children with developmental disabilities or congenital conditions affecting their mobility and positioning may require a seating and mobility referral to ensure appropriate support and function.

Overall, anyone experiencing challenges related to their mobility, seating, or daily functioning due to physical disabilities or limitations should discuss the possibility of a seating and mobility referral with their healthcare professional.

For pdfFiller’s FAQs

What is seating and mobility referral?

A seating and mobility referral is a process where individuals who require specialized seating and mobility equipment are connected with relevant healthcare professionals for assessment and recommendations.

Who is required to file seating and mobility referral?

Seating and mobility referrals are typically filed by healthcare professionals, such as physicians, physical therapists, or occupational therapists, who are working with individuals in need of specialized equipment.

How to fill out seating and mobility referral?

Seating and mobility referrals can be filled out by providing detailed information about the individual's medical history, current mobility limitations, and specific needs for seating and mobility equipment. This information is then submitted to the relevant healthcare provider for further assessment.

What is the purpose of seating and mobility referral?

The purpose of seating and mobility referral is to ensure that individuals with mobility impairments receive the appropriate assessment and recommendations for specialized equipment to improve their mobility, comfort, and overall quality of life.

What information must be reported on seating and mobility referral?

Information that must be reported on seating and mobility referral includes the individual's medical history, current mobility limitations, specific needs for seating and mobility equipment, and any other relevant information that may help healthcare professionals make accurate recommendations.

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