REQUIREMENTS FOR ORDERING CUSTOM MOBILITY DEVICES
A face-to-face exam notating that the patient presents for a potential need for a power mobility device.
- The examination should include: height, weight, cardiopulmonary function, musculoskeletal (including strength/ROM) capabilities and neurological condition.
- The patient’s medical history, relevant to patient’s mobility needs in the home, should also be addressed. Focus on the body systems responsible for ambulatory issues in the home.
Chart notes/medical documentation should include the following:
- Symptoms that limit ambulation and the diagnoses responsible for these symptoms (including medications or other treatments that have been tried for these symptoms and/or diagnoses).
- Progression of ambulatory difficulty and the diagnoses related.
- Observation of walking distance, gait, and pace of ambulation. Was an assistive device (cane or walker) used? Or is the patient unable to bear any weight?
- History and frequency of falls; injuries related to falls, and which type of assistive device (if any) was the patient using when they fell?
- Which assistive device is the patient currently using? If the patient is unable to use a cane, walker or manual wheelchair, please specify the cause/reason.
- Why does the patient require a power mobility device at this time?
- State whether or not a patient can/cannot safely transfer. If ordering a scooter, can the patient operate the tiller? Is there sufficient space in the home to maneuver the power mobility device being ordered?
- How will the power mobility device help your patient complete his/her mobility related aids to daily living? Please be specific " i.e., to prepare/eat meals, use bathroom, etc.
- If the patient has the cognitive ability to safely operate, and is willing to operate the equipment in his/her home, please include this statement.
If for any reason you cannot thoroughly document all of the requirements mentioned, you may elect to refer the patient to a physical or occupational therapist to perform part of this evaluation. If you refer your patient, an Rx is required from you for this evaluation. Also, include a referral statement in the chart notes. Once the evaluation is completed, it will be forwarded to you for a concurrence statement. The date of the concurrence statement will become the new face-to-face date. If you have any questions regarding these requirements, please contact us at (248) 658-0988.
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