Wheelchair Scooter Stroller Seating Assessment Form - Fill ... 2025

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The document is a Wheelchair/Scooter/Stroller Seating Assessment Form used for prior authorization requests related to the purchase or modification of wheeled mobility systems. It includes certification statements from providers regarding the accuracy of information provided, details on client assessments including neurological and postural control factors, medical history, functional assessments, environmental considerations, and requested equipment specifications. The form requires signatures from healthcare professionals and emphasizes compliance with Texas Medicaid regulations.

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

What are the principles of wheelchair seating?

The seating system used should provide adequate support while seated, maintain normal anatomic alignment while accommodating any fixed postural asymmetries, allow for adequate stability while sitting in a neutral position, promote function and the completion of ADLs/IADLs, and maximally distribute pressure.

What is the functional mobility and wheelchair assessment?

The Functional Mobility Assessment (FMA) is a measure that evaluates an individuals ability and satisfaction with a mobility device.

What is the functioning everyday with a wheelchair assessment?

The Functioning Every Day with a Wheelchair (FEW) test takes less than 15 minutes and correspondingly assesses activity while in a WC. It includes both the WC users and clinicians perspectives and measures performance in 10 different situations.

What is the purpose of the wheelchair assessment?

Information collected from the assessment will help the wheelchair service personnel and wheelchair user to; choose the most appropriate wheelchair from those available; determine the most appropriate wheelchair components from those available including any possible additional postural support required and decide what

What is the functional test for mobility?

Definition: The L Test of Functional Mobility (L Test) is a performance-based measure that can be used to assess physical function, including dynamic balance ability. The test is a modification of the Timed Up and Go (TUG) designed to overcome the ceiling effect of the TUG found in higher-functioning patients.

entity documentation

Medicare wheelchair evaluation form Wheelchair measurement form pdf Wheelchair assessment Occupational Therapy pdf Mobility Assessment form pdf Wheelchair seating assessment form Wheelchair evaluation form physical therapy Numotion Wheelchair Evaluation Form Power wheelchair assessment pdf

What is involved in a wheelchair assessment?

Our wheelchair assessments includes obtaining background information; identifying problems and goals: assessing current function, posture, mobility and equipment and a physical examination/simulation, if possible; and will offer recommendations if needed.

What is the code for wheelchair assessment?

Overview of Code 97542 Code 97542 is used to report management of a patient using a wheelchair including assessment (eg, pos- tural/positioning needs), fitting (eg, pressure relief), and training (eg, getting in and out of the wheelchair safely and managing wheelchair propulsion on various terrains).

What is included in functional mobility?

Functional mobility (getting from place to place while performing ADLs, such as getting into the tub, getting out of bed, moving from room to room. Functional mobility can refer to getting from place to place under your own power or with the assistance of a wheelchair or other assistive device.)