Get the free Wheelchair/Seating Evaluation Form (Form 384)

Alabama Medicaids DME Program, Clinical Services & Support Division and Quails Health Wheelchair/Seating Evaluation Form (Form 384) Cathy Carver, PT, ATP/SMS Physical Therapy Consultant Quails Health

How to fill out wheelchairseating evaluation form form

How to fill out wheelchairseating evaluation form form

1. To fill out the wheelchair seating evaluation form, follow these steps:
2. Start by providing the necessary patient information such as name, date of birth, and contact details.
3. Indicate the reason for the evaluation and any relevant medical history of the patient.
4. Evaluate the patient's functional abilities including mobility, transfers, and posture.
5. Assess the patient's current wheelchair and seating system if applicable.
6. Consider the patient's specific needs and goals for seating and mobility.
7. Select and document the appropriate wheelchair and seating options based on the evaluation.
8. Provide recommendations for any additional assistive devices or accessories needed.
9. Document any modifications or adjustments required for optimal seating and positioning.
10. Obtain the necessary signatures and contact information of the evaluating healthcare professional.
11. Once completed, submit the form to the appropriate healthcare provider or organization.

Who needs wheelchairseating evaluation form form?

1. The wheelchair seating evaluation form is typically needed by individuals who require a wheelchair or specialized seating system.
2. This may include individuals with physical disabilities, mobility impairments, or medical conditions that affect their ability to sit or move independently.
3. The form helps healthcare professionals assess and determine the most appropriate wheelchair and seating options for the individual's needs and functional abilities.

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What is wheelchairseating evaluation form form?

The wheelchair seating evaluation form is a document used to assess and document the seating needs of individuals who rely on wheelchairs for mobility.

Who is required to file wheelchairseating evaluation form form?

Medical professionals, such as physiotherapists, occupational therapists, and doctors, are typically required to fill out the wheelchair seating evaluation form.

How to fill out wheelchairseating evaluation form form?

The form should be completed by observing the individual in their wheelchair, conducting a physical assessment, and documenting any specific needs or adjustments.

What is the purpose of wheelchairseating evaluation form form?

The purpose of the form is to ensure that individuals using wheelchairs have proper seating that supports their posture, comfort, and overall well-being.

What information must be reported on wheelchairseating evaluation form form?

Information such as measurements, positioning needs, cushion preferences, and any special requirements must be reported on the wheelchair seating evaluation form.