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Prescribing Equipment - by Equipment Type

Allied Health, Safety and Rehabilitation Aids

Clinical Considerations for Use of Exercise Pedals (MS Word Document 94.0 KB)
DHS EP ACC Client Registration Form (MS Word Document 98.2 KB)
Advanced Palliative Equipment Response Assessment Request Form (MS Word Document 124.4 KB)
Specific Eligibility Criteria Rehabilitation Equipment (MS Word Document 113.5 KB)

Ambulant Mobility Aids and Accessories

Walkers Clinical Considerations for Prescribers (MS Word Document 137.5 KB)
Walking Aids Clinical Considertions for Prescribers (MS Word Document 135.5 KB)

Bathing Toileting and Continence Aids

Applying a Plastic Sheet Over Electrical Outlets Fact Sheet (MS Word Document 154.0 KB)
Bath Aids Clinical Considerations for Prescribers (MS Word Document 131.0 KB)
Bathroom Electrical Safety Clinical Considerations for Prescribers (MS Word Document 300.0 KB)
Bathroom Electrical Safety Training Resource Kit (MS Word Document 1.5 MB)
Bed Pan Clinical Considerations for Prescribers (MS Word Document 124.0 KB)
Bidet Specification and Agreement Form (MS Word Document 375.0 KB)
Commodes Clinical Considerations for Prescribers (MS Word Document 130.5 KB)
General Seating Initial Specification Form (MS Word Document 1.7 MB)
Mobile Shower Chair Clinical Considerations for Prescribers (MS Word Document 146.0 KB)
Mobile Shower Chair Seat Modifications Specification Form (MS Word Document 314.0 KB)
Mobile Shower Commode Chair Assessment Form (MS Word Document 532.3 KB)
Shower Chairs Clinical Considerations for Prescribers (MS Word Document 200.5 KB)
Shower Hoses Clinical Considerations for Prescribers (MS Word Document 135.0 KB)
Toiletting Aids Clinical Considerations for Prescribers (MS Word Document 135.5 KB)

Beds and Bed Accessories

Bed, Mattress and Bed Equipment Assessment Form (MS Word Document 306.0 KB)
Bed Assessment Clinical Considerations for Prescribers (MS Word Document 120.5 KB)
Bed Entrapment Zone Measuring Tool (MS Word Document 3.0 MB)
Bed Rails Clinical Considerations for Prescribers (MS Word Document 325.5 KB)
Bed Sticks Clinical Considerations for Prescribers (MS Word Document 388.5 KB)
Chair Bed Blocks or Bed Raiser Clinical Considerations for Prescribers (MS Word Document 227.0 KB)
Beds checklist’ to Checklist for the Prescription of Electric Beds for APER Clients (MS Word Document 344.2 KB)
Criteria Screening Tool, Electrically Operated Bed (MS Word Document 64.4 KB)
Customised chair form 2023 01 24 (MS Word Document 89.1 KB)
Electric Adjustable Bed Comparison Table (MS Word Document 451.1 KB)
Entrapment Zone Compliance Matrix (MS Word Document 79.2 KB)
Guide to Assessing Entrapment Risk (MS Word Document 122.5 KB)
Initial Considerations for an Electric Bed Prescription (MS Word Document 61.5 KB)
Instructions for Measuring Entrapment Zones (MS Word Document 2.2 MB)
Overway Bedtable Clinical Considerations for Prescribers (MS Word Document 134.5 KB)
Recognition of Prior Learning Assessing and Prescribing Adjustable Beds (MS Word Document 135.0 KB)
Specific Eligibility Criteria Electric Beds (MS Word Document 100.5 KB)

Car Devices

Car Hoist and Wheelchair Carrier Assessment (MS Word Document 95.6 KB)
Car Hoist and Wheelchair Carriers Clinical Considerations for Prescribers (MS Word Document 137.0 KB)
Criteria Screening Tool, Modified Driving Controls (MS Word Document 55.6 KB)
Criteria Screening Tool, Wheelchair Carrier (MS Word Document 64.6 KB)
Specific Eligibility Criteria Car Hoist (Person Lift Only) (MS Word Document 129.5 KB)
Specific Eligibility Criteria Modified Driving Controls (MS Word Document 109.0 KB)
Specific Eligibility Criteria Roof Mounted Wheelchair Carriers (MS Word Document 130.5 KB)
Specific Eligibility Criteria Towbar Mounted Wheelchair Carriers (MS Word Document 117.5 KB)

Home Access

Electronic Door Opener Specification and Agreement Form (MS Word Document 841.1 KB)

Household and Small Aids

Traymobile Clinical Considerations for Prescribers (MS Word Document 135.0 KB)

Person Transfer Aids

Ceiling Hoist Specification and Agreement Form (MS Word Document 145.9 KB)
Criteria Screening Tool, Hoist (MS Word Document 62.1 KB)
Hoist Assessment Form (MS Word Document 203.0 KB)
Hoists Clinical Considerations for Prescribers (MS Word Document 161.0 KB)
Sling Assessment Form (MS Word Document 189.0 KB)
Slings Clinical Considerations for Prescribers (MS Word Document 145.5 KB)
Specific Eligibility Criteria Ceiling Hoists (MS Word Document 109.5 KB)

Pressure Management and Seating

Braden Pressure Risk Scale (PDF 958.4 KB)
Cushion Comparison Table (MS Word Document 101.6 KB)
Guide to Assessing Pressure Risk Tool (MS Word Document 123.5 KB)
Pressure Mattresses Clinical Considerations for Prescribers (MS Word Document 156.0 KB)
ROHO Cell to Seat Size Convert (PDF 514.8 KB)
Wheelchair and Plinth (MAT) Clinical Considerations for Prescribers (MS Word Document 207.0 KB)
Wheelchair Initial Assessment Form (MS Word Document 294.5 KB)

Seated Mobility Aids and Accessories

Accessing a Wheelchair and Seating Service (MS Word Document 388.5 KB)
Care and Use of a Powered Mobility Aid (MS Word Document 139.5 KB)
Completing Powered Mobility Aid Clinical Review (MS Word Document 409.5 KB)
Motor Vehicle Transport of People in Wheelchairs (MS Word Document 163.5 KB)
Criteria Screening Tool, Scooter (MS Word Document 146.5 KB)
General Seating Initial Specification Form (MS Word Document 1.7 MB)
How Often Do a Client's Powered Mobility Aid Skills Need Review? (MS Word Document 141.0 KB)
How To Complete the Scooter and Wheelchair Specification Form (MS Word Document 120.0 KB)
Indicators For Medical Clearance of Powered Mobility Devices (MS Word Document 136.0 KB)
Manual Wheelchairs Clinical Considerations for Prescribers (MS Word Document 153.5 KB)
Medical Information Form (MS Word Document 197.0 KB)
Plinth (MAT) Assessment Form (PDF 1.4 MB)
Powered Mobility Formal Tests (MS Word Document 105.0 KB)
Powered Mobility Frequency of Clinical Review Indicators (MS Word Document 145.0 KB)
Powered Mobility Practical Assessment Form (MS Word Document 122.0 KB)
Scooter Assessment Form (MS Word Document 54.9 KB)
Scooter Specification Form (MS Word Document 98.1 KB)
Scooters Clinical Considerations for Prescribers (MS Word Document 134.5 KB)
Specific Eligibility Criteria Manual Wheelchairs (MS Word Document 113.0 KB)
Specific Eligibility Criteria Provision of a Powered Mobility Aid and a Manual Wheelchair or Non Standard Stroller (MS Word Document 64.2 KB)
Specific Eligibility Criteria Powered Mobility Aids for Outdoor Use (MS Word Document 144.5 KB)
Specific Eligibility Criteria Powered Wheelchairs (MS Word Document 156.5 KB)
Specific Eligibility Criteria Strollers (MS Word Document 148.5 KB)
Strollers Clinical Considerations for Prescribers (MS Word Document 152.5 KB)
Wheelchair and Plinth (MAT) Clinical Considerations for Prescribers (MS Word Document 207.0 KB)
Wheelchair Initial Assessment Form (MS Word Document 294.5 KB)
Wheelchair Initial Specification Form (MS Word Document 1.7 MB)
Wheelchairs Motor Vehicle Transportation Fact Sheet (MS Word Document 559.5 KB)
Wheelchairs Out and about Fact sheet (MS Word Document 788.5 KB)

Specialised Chairs and Accessories

Chair Bed Blocks or Bed Raiser Clinical Considerations for Prescribers (MS Word Document 227.0 KB)
Chair Raiser Clinical Considerations for Prescribers (MS Word Document 230.5 KB)
Criteria Screening Tool, Electric Riser Recliner Chair (MS Word Document 132.0 KB)
Electric Recliner Lift Chair Clinical Considerations for Prescribers (MS Word Document 133.0 KB)
Electric Recliner Lift Chair Assessment form (MS Word Document 597.0 KB)
General Seating Initial Specification Form (MS Word Document 1.7 MB)
Postural Chairs Clinical Considerations for Prescribers (MS Word Document 148.0 KB)
Pressure Reduction/Comfort Chair Assessment Form (MS Word Document 413.3 KB)
Pressure Reduction Comfort Chairs Clinical Considerations for Prescribers (MS Word Document 139.0 KB)
Specific Eligibility Criteria Electric Riser Recliner Chairs (MS Word Document 65.2 KB)
Specific Eligibility Criteria Posture Chairs (MS Word Document 134.5 KB)
Utility Chairs Clinical Considerations for Prescribers (MS Word Document 136.0 KB)

Splinting, Orthoses and Supports

Medical Grade Footwear and Lower Limb Orthoses Request Form 2023 04 04 (MS Word Document 167.4 KB)
Specific Eligibility Criteria Foot Orthoses and Ankle Foot Orthoses (MS Word Document 173.5 KB)
Specific Eligibility Criteria Medical Grade Footwear (MS Word Document 114.3 KB)

Technology, Access and Communication

Specific Eligibility Criteria Eye Gaze Technology (MS Word Document 161.0 KB)
Specific Eligibility Criteria Speech Generating Devices (MS Word Document 130.5 KB)
Specific Eligibility Criteria Technology (Computer Access) (MS Word Document 119.5 KB)
Specific Eligibility Criteria Technology (Environmental Control Systems) (MS Word Document 139.5 KB)

Wigs

DHS Equipment Program Wig Request Form (MS Word Document 62.8 KB)
Specific Eligibility Criteria for the Provision of Wigs (MS Word Document 46.6 KB)

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Last updated:01 Nov 2023 9:03pm

Government of South Australia

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Last updated:06 Nov 2023 11:47am

Government of South Australia

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URL:

https://equipmentprogram.sa.gov.au/lists/dhs-equipment-program-documents/prescribing-equipment-by-equipment-type

Last Updated:

27 Mar 2018

Printed on:

22 Dec 2024

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Government of South Australia