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Assistive Technology Consultation Intake Form Patient s Name Date Parents Names Address Apt City/State/Zip Telephone (home) Other work cell Birthdate MEDICAL BACKGROUND What is the diagnosed disability?

How to fill out assistive technology consultation intake

1. To fill out an assistive technology consultation intake, start by gathering all the necessary information and documents. This may include personal identification, medical history, and any documentation related to the individual's disability or specific needs.
2. Begin by providing basic personal information such as name, contact details, and date of birth in the appropriate sections of the intake form.
3. Next, provide details about the individual's disability or specific needs. This may include information about the type and severity of the disability, any specific assistive technology already being used, and any challenges or limitations faced by the individual.
4. Provide a comprehensive medical history, outlining any relevant diagnoses, treatments, and medications. This will help the assistive technology consultant to understand the individual's overall health and any specific factors that may impact the selection of appropriate technology.
5. Answer any additional questions or prompts on the intake form that are specific to the individual's situation. This may include questions about communication preferences, educational or vocational background, and goals or expectations related to assistive technology.
6. Be sure to review the completed intake form for accuracy and completeness before submitting it. Double-check all the information provided to ensure that nothing is missing or incorrect.

Who needs assistive technology consultation intake?

1. Individuals with disabilities who require assistive technology to enhance their independence, accessibility, or communication.
2. People who have experienced changes in their abilities or functional limitations and may need new or different assistive technology.
3. Students who may require assistive technology devices or services to support their learning and educational goals.
4. Individuals who are seeking guidance or recommendations on selecting appropriate assistive technology devices or services.
5. Caregivers or family members who are seeking assistance for their loved ones with disabilities and need professional advice on assistive technology options.

Remember, it is always important to consult with a professional assistive technology consultant to ensure that the intake process is conducted accurately and effectively.

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What is assistive technology consultation intake?

Assistive technology consultation intake is the process of gathering information about an individual's need for assistive technology devices or services.

Who is required to file assistive technology consultation intake?

Individuals with disabilities or their representatives are required to file assistive technology consultation intake.

How to fill out assistive technology consultation intake?

Assistive technology consultation intake can be filled out by providing detailed information about the individual's needs, goals, and any existing assistive technology devices or services.

What is the purpose of assistive technology consultation intake?

The purpose of assistive technology consultation intake is to assess the individual's need for assistive technology and determine the appropriate devices or services to support their independence and participation in daily activities.

What information must be reported on assistive technology consultation intake?

Information such as the individual's demographic details, medical history, current functional limitations, goals for using assistive technology, and any existing devices or services must be reported on assistive technology consultation intake.