FORMS

All the forms you need are here:

Power Mobility Device Evaluation Form for Physicians (PDF 173K)

• Form checklist
• Face-to-face evaluation
• Power mobility prescription form

Medicare Coverage Requirements (PDF 35K)

• Step-by-step instructions on what must be completed for your patient to receive power mobility devices and accessories

Choosing the Right Power Mobility Device (PDF 451K)

• Information to help you determine the appropriate power mobility device for your specific patient

Mobility Assistive Equipment Algorithm (PDF 52K)

• A process document to use as you consider the various types of mobility assistive equipment for your patient

Have questions? We are here to help, call the Professional Healthcare Hotline at 1-888-344-2181.