Domiciliary Equipment ServiceDomiciliary Equipment Service
Submitting a request for Equipment or Home Modification
Details of the requirements of the equipment or home modification need to be recorded on a request form.
- Equipment Request Form - DHS Equipment Program (DOCX 119.5 KB)
- Equipment Selection Agreement Form (DOC 153.0 KB)
- Home Modification Request and Agreement Form - DHS Equipment Program (DOC 207.5 KB) (DOCX 129.9 KB)
All Category 2 items must be submitted with:
- Delegate Approval Request Form (DOCX 106.3 KB)
- Any Relevant Assessment Forms (refer to any relevant in-scope list)
- Risk Rating and Priority Scoring Form (DOC 153.5 KB) OR
- Priority Scoring Communication and Assistive Technology (DOC 161.0 KB)
An additional specification form may be needed if measurements or adjustments to the item need to be detailed. Any customised equipment item must also have an Equipment Selection Agreement Form (DOCX 144.4 KB) completed with the client.
- Checklist For Assessors Submitting Equipment Requests (DOC 193.5 KB)
- Checklist For Assessors Submitting Home Modification Requests (DOCX 71.7 KB)
Please ensure that individuals and their carers read the following document prior to planning and commencing major home modifications:
Further information can be found on the Assistive Technology Services - Ordering page.