Contact us: 1300 130 302
- Advanced Palliative Equipment Response
- Disability Aged Clients and Customised Mobility
- Community Connections Program (CCP)
- Approved disciplines as assessors
- Documents supporting equipment selection
- Documents supporting home modification selection
- Delivery and Installation
- Collections and Returns
- Transferring Equipment Ownership
- Terms and Conditions, Privacy, Rights and Responsibilities
- Glossary of Common Terms
Prescription and Request Forms
Equipment needs to be ordered using a prescription form. Select the correct form, depending on the funding that is being used and the category of the item.
- Equipment Request Form - DHS Equipment Program (DOCX 125.7 KB)
- Home Modification Request and Agreement Form - DHS Equipment Program (DOCX 93.0 KB)
Category 2 items also require:
- Delegate approval form
- Risk Rating and Priority Scoring Form OR Priority Scoring Communication and Assistive Technology.
Additional forms (for example, screening tool, specification form) may also be required for more complex prescriptions. This enables the appropriate item to be provided to meet the person’s needs.
All prescription and request forms can be faxed to 1300 295 839 or emailed to DHSEquipmentProgram@sa.gov.au.