Dshs 2026

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233 votes

The document outlines the process for obtaining medical necessity approval for wheelchair purchases for nursing facility clients. It includes detailed instructions for physical and occupational therapists to complete a form that captures client information, medical diagnoses, equipment specifications, and justifications for the requested wheelchair or accessories. The form must be submitted within 60 days and requires signatures from both the therapist and prescribing physician.

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Click ‘Get Form’ to open the dshs document in the editor.
Begin by entering the CLIENT NAME and CLIENT ID in the designated fields. Ensure all information is accurate.
Indicate whether there is an RX ON FILE by selecting 'YES' or 'NO'. If applicable, provide details about the NURSING FACILITY and FAX NUMBER.
In the diagnosis section, describe any relevant disabilities and medical history related to the requested equipment. Be specific about contractures and pressure wounds.
Fill in patient measurements including HEIGHT, WEIGHT, LOWER LEG LENGTH, UPPER LEG LENGTH, and HIP WIDTH. This data is crucial for determining appropriate equipment.
Complete sections regarding ambulation status, mobility aids used, and transfer status. Specify if a power wheelchair is needed and justify its necessity.
Finally, ensure both the PHYSICAL/ OCCUPATIONAL THERAPIST’S SIGNATURE and PHYSICIAN’S SIGNATURE are included before submitting your form.

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Versions	Form popularity	Fillable & printable
2010	4.9 Satisfied (233 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Can DSHS check your bank account?

ing to the California Department of Social Services, if you dont have pay stubs or an income statement from your employment, the caseworker at the food stamp office may use the bank records to prove your income.

Why is Texas DSHS calling me?

The Texas Behavioral Risk Factor Surveillance System (BRFSS) is currently being conducted. If you receive a phone call on behalf of the Texas Department of State Health Services and CDC asking you to answer some questions about your health and health practices, it is a legitimate phone call.

Can government agencies check your bank account?

Without your consent, a Federal agency that wants to see your financial records may do so ordinarily only by means of a lawful subpoena, summons, formal written request,or search warrant for that purpose.

Can the food stamp office see your bank account?

When applying for food stamps, you will be required to submit proof of your monthly income and liquid assets, but the agency you apply through will not look directly into your bank accounts to verify.

What is the phone number for Washington DSHS eligibility review?

Call 1-877-501-2233 Monday-Friday, except holidays, to reach a Customer Service Contact Center agent to: Apply for benefits, complete an interview or complete a review from 8 a.m. to 2 p.m.