Get the free Wheelchair Referral form

East Berkshire Specialist Wheelchair Service 3 Bell Gardens Maidenhead Berkshire SL6 6PS Tel: 01189 043222 berkseast.mobility@berkshire.nhs.uk www.berkshirehealthcare.nhs.ukWHEELCHAIR REFERRAL FORM

How to fill out wheelchair referral form

How to fill out wheelchair referral form

1. Gather all necessary information such as patient's personal details, medical history, and insurance information.
2. Consult with a healthcare professional who can provide a recommendation for a wheelchair.
3. Obtain the wheelchair referral form from the healthcare professional or medical facility.
4. Fill out the form completely and accurately, providing detailed information about the patient's condition and mobility needs.
5. Submit the completed form to the appropriate agency or insurance company for approval.
6. Follow up with the healthcare professional or agency to ensure the wheelchair is provided in a timely manner.

Who needs wheelchair referral form?

1. Individuals who have mobility issues and require a wheelchair to assist with their daily activities.
2. Patients who have received a recommendation from a healthcare professional for a wheelchair.

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What is wheelchair referral form?

Wheelchair referral form is a document used to request a wheelchair for a patient who needs mobility assistance.

Who is required to file wheelchair referral form?

Healthcare providers, such as physicians, physical therapists, or occupational therapists, are required to file wheelchair referral forms on behalf of their patients.

How to fill out wheelchair referral form?

The healthcare provider must fill out the form with the patient's information, medical history, and justification for the need of a wheelchair.

What is the purpose of wheelchair referral form?

The purpose of wheelchair referral form is to ensure that patients in need of mobility assistance receive the appropriate equipment.

What information must be reported on wheelchair referral form?

The wheelchair referral form must include the patient's name, date of birth, diagnosis, anticipated duration of wheelchair use, and the healthcare provider's contact information.