NJ Horizon Mobility Evaluation Report for Power Wheelchair 2015 free printable template

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How to fill out NJ Horizon Mobility Evaluation Report for Power

How to fill out NJ Horizon Mobility Evaluation Report for Power Wheelchair

1. Begin by gathering necessary personal information, including the patient's name, address, and contact information.
2. Fill out the medical history section, detailing any relevant diagnoses, existing conditions, and previous mobility aids used.
3. Provide information about the patient's current mobility status, including their ability to walk and transfer.
4. Complete the assessment of functional limitations, using specific metrics for mobility, balance, and endurance.
5. Include any recommendations for the type of power wheelchair needed based on the patient's mobility needs.
6. Make sure to sign and date the report, and include the clinician's credentials.

Who needs NJ Horizon Mobility Evaluation Report for Power Wheelchair?

1. Individuals with mobility impairments who require a power wheelchair for independence in daily activities.
2. Healthcare professionals assisting patients in obtaining mobility aids through insurance or other support.
3. Patients undergoing a mobility evaluation to qualify for financial assistance or coverage for a power wheelchair.

People Also Ask about

What is ICD 10 code for wheelchair eval?

Wheelchair Mobility Assessment ICD-10-PCS F01ZFZZ is a specific/billable code that can be used to indicate a procedure.

What is the ICD 10 code for mobility assessment?

Wheelchair Mobility Assessment ICD-10-PCS F01ZFZZ is a specific/billable code that can be used to indicate a procedure.

What is the CPT code for power mobility device evaluation?

Overview of Code 97755 Assistive technology includes user-interface technology and/or shared control between the user and the device, such as power mobility devices (including adaptive switches and access devices), prosthetic limb control devices, functional electrical stimulation devices, and robotic exoskeletons.

What is a wheelchair evaluation?

It is a form of biomechanical assessment and physical evaluation, forms the second part of the Wheelchair Assessment Process, and consists of three elements, with information from each of these assisting wheelchair service personnel to decide how much support the wheelchair user needs.

What is the HCPCS code for power mobility device?

Wheelchairs, Power Operated HCPCS Code range K0813-K0899.

What is a mobility evaluation?

A face-to-face mobility examination, sometimes referred to as an in-office mobility evaluation, is a required doctor's office visit. It is mandated by Medicare and must occur prior to receiving a power wheelchair prescription. Patient mobility must be the primary focus of the examination.

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What is NJ Horizon Mobility Evaluation Report for Power Wheelchair?

The NJ Horizon Mobility Evaluation Report for Power Wheelchair is a document used to assess an individual's mobility needs and eligibility for a power wheelchair through NJ Horizon's insurance coverage.

Who is required to file NJ Horizon Mobility Evaluation Report for Power Wheelchair?

Healthcare providers such as physicians or qualified therapists are required to file the NJ Horizon Mobility Evaluation Report for Power Wheelchair on behalf of patients seeking coverage for a power wheelchair.

How to fill out NJ Horizon Mobility Evaluation Report for Power Wheelchair?

To fill out the NJ Horizon Mobility Evaluation Report for a Power Wheelchair, healthcare providers must accurately complete sections detailing the patient's medical history, mobility assessment, and justification for the need for a power wheelchair, along with any supporting documentation.

What is the purpose of NJ Horizon Mobility Evaluation Report for Power Wheelchair?

The purpose of the NJ Horizon Mobility Evaluation Report for Power Wheelchair is to provide a thorough assessment and justification for the necessity of a power wheelchair for the patient, ensuring that the insurance company can evaluate the request for coverage appropriately.

What information must be reported on NJ Horizon Mobility Evaluation Report for Power Wheelchair?

The NJ Horizon Mobility Evaluation Report for Power Wheelchair must report information such as the patient's medical diagnoses, mobility limitations, functional abilities, previous equipment used, and reasons for the recommendation of a power wheelchair.