Manual Wheelchair Eligibility Criteria
The patient must meet the following criteria to qualify for a manual wheelchair:
- Mobility limitation that significantly impairs ability to participate in mobility-related activities of daily living (MRDAL)
- Mobility limitation cannot be sufficiently resolved by the use of an appropriately fitted cane or walker
- Home provides adequate access and maneuvering space for the manual wheelchair
- Use of a manual wheelchair will significantly improve the patient’s ability to participate in MRADLs
- Patient has sufficient upper extremity function and other physical and mental capabilities needed to safely self-propel the manual wheelchair
- Patient has a caregiver who is available, willing, and able to provide assistance with the wheelchair
Accessories Qualifying Criteria
Accessories such as seat and back cushions, adjustable arms, elevating legrests, safety belts, anti-tippers, wheel lock extensions, and heel loops have specific qualifying criteria.
KOO03 Standard Lightweight Wheelchair
To qualify for a KOO03 Wheelchair, the patient must meet the above criteria and:
- Cannot self-propel in a standard wheelchair in the home
- Can and does self-propel in a lightweight wheelchair
Manual:
Download: Manual Wheelchair Eligibility Flowchart Ko003
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