Patient being seen today for evaluation of wheelchair.
The patient has a mobility limitation that significantly impairs ability to participate in one or more mobility related activities of mobility related activities of daily living such as toileting, feeding, dressing, grooming and bathing in customary locations in the residence/facility. The patient's mobility limitation can not be sufficiently resolved by the use of an appropriately fitted cane or walker. The patient's residence/facility provides adequate access between rooms, maneuvering space, and surfaces for the use the manual wheelchair and the manual wheelchair will significantly improve the patient's ability to participate in mobility related activities of daily living. The patient will use the wheelchair on a regular basis in the home and the patient has not expressed an unwillingness to use the manual wheelchair that is provided in the residence/facility. The patient has a sufficient upper extremity function and other physical and mental capabilities needed to safely self-propel the manual wheelchair that is provided in the home during a typical day.
Patient meets criteria for wheelchair for use to perform mobility related activities of daily living.