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WHEELCHAIR REFERRAL FORM Highland Wheelchair & Seating Services Dept of Medical Physics and Bioengineering Raigmore Hospital, INVERNESS, IV2 3UJ Tel No: 01463 704167 Fax No 01463 705717Please note

How to fill out wheelchair referral - fill

How to fill out wheelchair referral form

1. Obtain a wheelchair referral form from a healthcare professional or a healthcare facility.
2. Fill out the patient's personal information section, including their name, address, date of birth, and contact information.
3. Provide information about the patient's medical condition or disability that requires the use of a wheelchair.
4. Include any relevant medical history or documentation from healthcare providers.
5. Indicate the type of wheelchair or assistive device needed and any specific requirements or modifications.
6. If applicable, provide information about insurance coverage or funding options for the wheelchair.
7. Review the completed form for any mistakes or missing information before submitting it.
8. Submit the filled-out wheelchair referral form to the appropriate healthcare professional or healthcare facility for further processing.

Who needs wheelchair referral form?

1. Individuals who require a wheelchair or assistive device for mobility purposes
2. Individuals with physical disabilities or medical conditions that affect their mobility
3. Patients who have been recommended a wheelchair by a healthcare professional
4. Individuals who need a wheelchair for temporary or permanent use

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What is wheelchair referral form?

The wheelchair referral form is a document used to assess and recommend the appropriate wheelchair for individuals requiring mobility assistance.

Who is required to file wheelchair referral form?

Typically, healthcare providers such as doctors or occupational therapists are required to file the wheelchair referral form on behalf of the patient.

How to fill out wheelchair referral form?

To fill out a wheelchair referral form, you must provide patient identification information, medical history, mobility needs, and any specific requirements for the wheelchair.

What is the purpose of wheelchair referral form?

The purpose of the wheelchair referral form is to ensure that individuals receive the most suitable wheelchair for their medical and mobility needs.

What information must be reported on wheelchair referral form?

The form must report patient demographics, medical conditions, functional limitations, and any special features needed in the wheelchair.