Documents and Forms for Prescribing Power Mobility Equipment

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Prescription

Physician Packet for Power Chairs (PDF 165K)
A cover letter describing what needs to be filled out, a face-to-face evaluation and a power mobility prescription form for patients who are being prescribed a power chair.
Physician Packet for Scooters (PDF 128K)
A cover letter describing what needs to be filled out, a face-to-face evaluation and a power mobility prescription form for patients who are being prescribed a power scooter.

Medicare Coverage Requirements (PDF 35K)
This Medicare document reviews step-by-step what physicians must complete in order for their patient to receive power mobility devices and accessories.
Choosing the Right Power Mobility Device (PDF 451K)
Information on products to be used by the treating physician and practitioner when determining the appropriate power mobility device to prescribe.
Mobility Assistive Equipment Algorithm (PDF 52K)
A process document for the treating physician or practitioner to use when considering all types of mobility assistive equipment for their patients.
FAQs Regarding Power Mobility Devices (PDF 31K)
Frequently asked questions relating to power mobility devices and Medicare coverage.

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