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Seating and Mobility Referral Form Name: Date of Birth: Diagnosis: Date: *Eligibility for funding of equipment through the Assistive Devices Program of Ontario (ADP) will be discussed with families

How to fill out seating and mobility referral

How to fill out seating and mobility referral:

1. Begin by obtaining the necessary referral form from the healthcare provider or organization. This form may be available online or can be requested from the provider's office.
2. Fill out the patient's personal information accurately, including their name, date of birth, contact information, and insurance details. This information is necessary for proper identification and billing purposes.
3. Provide a detailed description of the patient's medical condition or mobility limitations that require seating and mobility equipment. Include information on any relevant medical history, diagnoses, and current treatment plans.
4. Specify the type of seating and mobility equipment needed. This can include manual or power wheelchairs, specialized cushions, positioning systems, or other assistive devices. Provide as much detail as possible to ensure proper equipment selection.
5. Indicate if there are any specific preferences or requirements for the equipment, such as specific brands, features, or functionalities. This information can help the provider meet the patient's specific needs and preferences.
6. If applicable, include any supporting documentation, such as medical reports, assessments, or prescriptions, that may be required by the healthcare provider or insurance company for approval.
7. Review the completed referral form for accuracy and completeness before submitting it. Ensure that all required fields are filled out and double-check for any spelling or typographical errors.
8. Follow the provider's instructions for submitting the referral form. This may involve mailing, faxing, or submitting the form electronically through an online portal.
9. Keep a copy of the completed referral form for your records. This can be useful for reference or in case there are any questions or issues with the referral process.

Who needs seating and mobility referral?

1. Individuals with mobility limitations due to physical disabilities, injuries, or medical conditions may need a seating and mobility referral. This can include individuals with conditions such as spinal cord injuries, muscular dystrophy, cerebral palsy, multiple sclerosis, or amputations.
2. People who have difficulty walking or maintaining a seated position independently may require seating and mobility equipment to enhance their mobility, independence, and quality of life.
3. The need for a seating and mobility referral may also depend on the specific requirements of the individual's insurance coverage or funding sources. It is advisable to check with the insurance provider or healthcare organization to determine if a referral is necessary in each case.

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What is seating and mobility referral?

Seating and mobility referral is a process where individuals are referred to specialists for assessment and provision of customized seating and mobility devices to meet their specific needs.

Who is required to file seating and mobility referral?

Healthcare professionals such as physicians, physical therapists, and occupational therapists are required to file seating and mobility referral.

How to fill out seating and mobility referral?

Seating and mobility referral can be filled out by providing patient information, medical history, mobility needs, and any other relevant details to the specialist.

What is the purpose of seating and mobility referral?

The purpose of seating and mobility referral is to ensure that individuals with mobility impairments have access to the appropriate seating and mobility devices to improve their quality of life.

What information must be reported on seating and mobility referral?

Information such as patient demographics, medical history, mobility limitations, and any specific seating or mobility device recommendations must be reported on seating and mobility referral.