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Appendix B Name: Wheelchair Seating Evaluation and Justification Date: MR #: Account #: Physician: Diagnosis: PATIENT INFORMATION: Name: DOB: Address: Sex: Date seen: Caregiver: Physical / Occupational
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Wheelchair seating evaluation is a process to assess the seating and positioning needs of individuals using wheelchairs.
Individuals using wheelchairs who need assessment of their seating and positioning needs are required to have a wheelchair seating evaluation.
To fill out a wheelchair seating evaluation, a certified seating specialist or healthcare provider will assess the individual's needs and make recommendations for appropriate seating and positioning.
The purpose of wheelchair seating evaluation is to ensure individuals using wheelchairs have appropriate seating and positioning to promote comfort, support, and prevent complications.
Information reported on wheelchair seating evaluation includes the individual's medical history, physical assessment, seating and positioning needs, and recommended equipment.
The deadline to file a wheelchair seating evaluation in 2023 may vary depending on the individual's specific needs and healthcare provider's recommendations.
The penalty for late filing of wheelchair seating evaluation may vary depending on the healthcare provider's policies and insurance coverage.
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