Wheelchair assessment 2026

1. Click ‘Get Form’ to open the wheelchair assessment in the editor.
2. Begin by filling out the Client Information section. Enter the client's first name, last name, Medicaid number, date of birth, diagnosis, height, and weight.
3. Proceed to Section I: Neurological Factors. Indicate the client’s muscle tone and describe any active or passive movements affected by it.
4. In Section II: Postural Control, assess head control, trunk control, and extremities. Select the appropriate options for each category.
5. Move to Section III: Medical/Surgical History And Plans. Answer questions regarding skin breakdown history and describe any orthopedic conditions.
6. Complete Section IV: Functional Assessment by indicating ambulation status and transfer capabilities. Provide details on feeding and dressing assistance levels.
7. In Section V: Environmental Assessment, describe the client's living environment and accessibility features like ramps.
8. Fill out Section VI: Requested Equipment with details about the current seating system and medical necessity for requested equipment.
9. Finally, ensure all signatures are completed in Sections VII and IX by both the therapist/physician and Qualified Rehabilitation Professional (QRP).

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