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ASHE WHEELCHAIR INTAKE Formation Name: Date: CSR: Referral Name: Title: Contact pH #: 1. What is the limitation of mobility (impairment of ambulation) that requires an assistive device? Diagnoses
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What is AHHE WHEELCHAIR INTAKE Form?

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AHHE WHEELCHAIR INTAKE template instructions

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The AHHE wheelchair intake form is a document used to gather information about individuals who require a wheelchair for medical purposes.
Individuals who need a wheelchair for medical purposes are required to file the AHHE wheelchair intake form.
The AHHE wheelchair intake form can be filled out by providing all the required information such as personal details, medical history, and the reason for needing a wheelchair.
The purpose of the AHHE wheelchair intake form is to assess the need for a wheelchair for medical purposes and to provide appropriate assistance.
The AHHE wheelchair intake form may require information such as personal details, medical history, healthcare provider information, and the reason for needing a wheelchair.
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