Contact us:
1300 295 786
Domiciliary Equipment Service
Domiciliary Equipment Service
DHS Equipment Program Documents
The document lists found under this tab are related to The DCSI Equipment Program. A brief description below outlines what can be found in each tab:
Document List Information
| Document List Name | Description |
|---|---|
| Eligibility Documents | A list of all specific eligibility and criteria screening tool documents |
| Prescribing Equipment - by Document Type | A list of documents related to prescribing equipment which are sorted according to the type of document |
| Prescribing Equipment - by Equipment Type | A list of documents related to prescribing equipment which are sorted according to the type of equipment |
| Approvals | Documents related to gaining approval for the prescription of equipment or home modifications |
| Follow up and Review | Documents related to follow up and review processes |
| Repairs and Maintenance | Documents related to repairs and maintenance of equipment and home modifications |
| Collections and Returns | Documents related to the collections and return of equipment |
| Becoming a Prescriber | Documents related to becoming a registered prescriber for the DCSI Equipment Program |
| Training | Documents related to training provided through the DCSI Equipment Program |
| Equipment Procedures | A list of all equipment procedures for the DCSI Equipment Program |
| Home Modification Procedures | A list of all home modification procedures for the DCSI Equipment Program |
Equipment Program Eligibility Documents
Equipment Program Eligibility Documents
[ ** RECURSION WARNING ** ]You are nesting the content of this page inside itself
Equipment (20)
Home Modification (6)
Screening Tools (6)
Equipment (20)
Home Modification (6)
Screening Tools (6)
Prescribing Equipment - by Document Type
Prescribing Equipment - by Document Type
Checklists
Checklist For Assessors Submitting Equipment Requests (MS Word Document 78.1 KB)- Checklist For Assessors Submitting Home Modification Requests (MS Word Document 78.3 KB)
Clinical Considerations for Prescribers
- Bariatric Equipment Clinical Considerations for Prescribers (MS Word Document 145.5 KB)
- Bath Aids Clinical Considerations for Prescribers (MS Word Document 131.0 KB)
- Bathroom Clinical Considerations for Prescribers (MS Word Document 162.5 KB)
- Bathroom Electrical Safety Clinical Considerations for Prescribers (MS Word Document 300.0 KB)
- Bed Assessment Clinical Considerations for Prescribers (MS Word Document 120.5 KB)
- Bed Pan Clinical Considerations for Prescribers (MS Word Document 124.0 KB)
- Bed Rails Clinical Considerations for Prescribers (MS Word Document 325.5 KB)
- Bed Sticks Clinical Considerations for Prescribers (MS Word Document 388.5 KB)
- Car Hoist and Wheelchair Carriers Clinical Considerations for Prescribers (MS Word Document 137.0 KB)
- 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)
- Clinical Considerations for Use of Exercise Pedals (MS Word Document 94.0 KB)
- Commodes Clinical Considerations for Prescribers (MS Word Document 130.5 KB)
- Motor Vehicle Transport of People in Wheelchairs (MS Word Document 163.5 KB)
- Electric Recliner Lift Chair Clinical Considerations for Prescribers (MS Word Document 133.0 KB)
- Grab Rails Clinical Considerations for Prescribers (MS Word Document 148.5 KB)
- Hoists Clinical Considerations for Prescribers (MS Word Document 161.0 KB)
- Kitchen Clinical Considerations for Prescribers (MS Word Document 148.5 KB)
- Manual Wheelchairs Clinical Considerations for Prescribers (MS Word Document 153.5 KB)
- Mobile Shower Chair Clinical Considerations for Prescribers (MS Word Document 146.0 KB)
- Overway Bedtable Clinical Considerations for Prescribers (MS Word Document 134.5 KB)
- Postural Chairs Clinical Considerations for Prescribers (MS Word Document 148.0 KB)
- Pressure Mattresses Clinical Considerations for Prescribers (MS Word Document 156.0 KB)
- Pressure Reduction Comfort Chairs Clinical Considerations for Prescribers (MS Word Document 139.0 KB)
- Ramps Clinical Considerations for Prescribers (MS Word Document 156.0 KB)
- Scooters Clinical Considerations for Prescribers (MS Word Document 134.5 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)
- Slings Clinical Considerations for Prescribers (MS Word Document 145.5 KB)
- Steps Clinical Considerations for Prescribers (MS Word Document 146.5 KB)
- Strollers Clinical Considerations for Prescribers (MS Word Document 152.5 KB)
- Toiletting Aids Clinical Considerations for Prescribers (MS Word Document 135.5 KB)
- Traymobile Clinical Considerations for Prescribers (MS Word Document 135.0 KB)
- Utility Chairs Clinical Considerations for Prescribers (MS Word Document 136.0 KB)
- Walkers Clinical Considerations for Prescribers (MS Word Document 137.5 KB)
- Walking Aids Clinical Considertions for Prescribers (MS Word Document 135.5 KB)
- Wheelchair and Plinth (MAT) Clinical Considerations for Prescribers (MS Word Document 207.0 KB)
Criteria Screening Tools
- Criteria Screening Tool, Ceiling Hoist (MS Word Document 96.5 KB)
- Criteria Screening Tool, Electrically Operated Bed (MS Word Document 100.8 KB)
- Criteria Screening Tool, Modified Driving Controls (MS Word Document 98.2 KB)
- Criteria Screening Tool, Scooter (MS Word Document 99.5 KB)
- Criteria Screening Tool, Wheelchair Carrier (MS Word Document 98.9 KB)
- Criteria Screening Tool, Electric Riser Recliner Chair (MS Word Document 132.0 KB)
Fact Sheets
- 4 Wheeled Walkers Fact sheet (MS Word Document 1.8 MB)
- Absorbent Sheet Fact Sheet (MS Word Document 241.0 KB)
- Applying a Plastic Sheet Over Electrical Outlets Fact Sheet (MS Word Document 154.0 KB)
- Bathboards and Benches Fact Sheet (MS Word Document 337.5 KB)
- Bed Rail Fact Sheet (MS Word Document 1.2 MB)
- Bed Stick Fact Sheet (MS Word Document 673.0 KB)
- Client Information Access to Interpreting Service Reference Guide (MS Word Document 103.5 KB)
- Client Information Privacy and Personal Information Statement (MS Word Document 115.9 KB)
- Client Information Your Rights and Responsibilities Form (MS Word Document 149.5 KB)
Consumers With Disability—Where to go for advice or complaints (PDF 328.8 KB)- Manual Wheelchairs Fact Sheet (MS Word Document 512.0 KB)
- Crutches Fact Sheet (MS Word Document 148.0 KB)
- Hoists Fact sheet (MS Word Document 338.5 KB)
- Mobile Shower Commode Chair Fact Sheet (MS Word Document 295.0 KB)
- Mobility Vehicle Modifications SA Service Providers Reference Guide (MS Word Document 2.4 MB)
- Portable DECPAC Ramp Fact Sheet (MS Word Document 372.5 KB)
- Pressure Care Mattresses Fact Sheet (MS Word Document 278.0 KB)
- Pressure Redistributing Cushions Fact Sheet (MS Word Document 338.5 KB)
- Self Help Pole Fact Sheet (MS Word Document 168.5 KB)
- Shower Chair and Stools Fact Sheet (MS Word Document 244.5 KB)
- Shower Hose Fact Sheet (MS Word Document 162.0 KB)
- Slide Sheet Fact Sheet (MS Word Document 1.8 MB)
- Slings Fact Sheet (MS Word Document 271.5 KB)
- Toilet Aid Fact Sheet (MS Word Document 301.0 KB)
- Tray Mobile Fact Sheet (MS Word Document 173.0 KB)
- Triwalker Fact sheet (MS Word Document 197.0 KB)
- Walking and Quad Sticks Fact Sheet (MS Word Document 295.5 KB)
- Walking Frames Fact Sheet (MS Word Document 261.0 KB)
- Wheelchairs Motor Vehicle Transportation Fact Sheet (MS Word Document 559.5 KB)
- Wheelchairs Out and about Fact sheet (MS Word Document 788.5 KB)
Flyers
- ACTS Lowtech and Static Display AAC Options (MS Word Document 1.6 MB)
- Mounting for Assistive Technology Session Flyer (MS Word Document 1.6 MB)
- Advanced Access Options Session Flyer (MS Word Document 1.6 MB)
- Beds and Bed Equipment Series Flyer (MS Word Document 112.5 KB)
- DES Information Sessions Flyer (MS Word Document 1.4 MB)
- Electrical Safety and Bathroom Design Flyer (MS Word Document 109.5 KB)
- Equipment Program and DES Orientation for External Prescribers Flyer (MS Word Document 177.5 KB)
- Equipment Program and DES Orientation for Internal Prescribers Flyer (MS Word Document 177.0 KB)
- Home Modifications Series Flyer (MS Word Document 114.0 KB)
- Management of the Bariatric Client (MS Word Document 428.5 KB)
- Orientation to DES and the DHS Equipment Program Flyer (PDF 395.4 KB)
- Pressure Injury Prevention Series Flyer (MS Word Document 117.5 KB)
- The Legal Responsibilities of Equipment Prescription Flyer (MS Word Document 107.5 KB)
- Using DES as your NDIS Assistive Technology Provider Flyer (PDF 101.4 KB)
- Wheelchair and Seating Series Session 1 Prescribing and Adjusting Manual Wheelchairs (MS Word Document 122.0 KB)
- Wheelchair and Seating Series Session 2 Assessing Capacity in the use of a powered mobility aid (MS Word Document 126.0 KB)
- Wheelchair and Seating Series Session 3 Prescribing and Adjusting Powered Wheelchairs (vA7134986). (MS Word Document 180.0 KB)
- Wheelchair and Seating Series Session 7 Prescribing and Adjusting Powered Wheelchairs Refresher (MS Word Document 107.8 KB)
- Wheelchair and Seating Series Sessions 4 and 5 (MS Word Document 105.5 KB)
Forms - Agreement
- DES AT Training Health Professionals Registration and Agreement Form (MS Word Document 58.3 KB)
- DES Major Home Modification Satisfactory Completion Agreement Form (MS Word Document 51.9 KB)
- Electronic Door Opener Specification and Agreement Form (MS Word Document 820.7 KB)
- Equipment Selection Agreement Form (MS Word Document 144.4 KB)
- Imprest Delivery Agreement Form (MS Word Document 91.0 KB)
Forms - Assessment
- Advanced Palliative Equipment Response Assessment Request Form (MS Word Document 183.9 KB)
- Bed, Mattress and Bed Equipment Assessment Form (MS Word Document 306.0 KB)
- Car Hoist and Wheelchair Carrier Assessment (MS Word Document 95.6 KB)
- Dynamic Client Profile AAC (MS Word Document 90.5 KB)
- Dynamic Client Profile CAT (MS Word Document 100.0 KB)
- Dynamic Client Profile ECS (MS Word Document 100.0 KB)
- Dynamic Client Profile MOUNT (MS Word Document 99.5 KB)
- Electric Recliner Lift Chair Assessment form (MS Word Document 597.0 KB)
- Foot Ankle Orthoses Medical Grade Footwear Assessment Form (MS Word Document 92.0 KB)
- Hoist Assessment Form (MS Word Document 203.0 KB)
- Major Bathroom Modification Assessment Form (MS Word Document 157.5 KB)
- Major Kitchen Modification Assessment Form (MS Word Document 126.5 KB)
- Medical Information Form (MS Word Document 197.0 KB)
- Mobile Shower Commode Chair Assessment Form (MS Word Document 532.3 KB)
- Plinth (MAT) Assessment Form (PDF 1.4 MB)
- Powered Mobility Aid Practical Assessment Route (Woodville Clinic Site) (MS Word Document 88.0 KB)
- Powered Mobility Formal Tests (MS Word Document 105.0 KB)
- Powered Mobility Practical Assessment Form (MS Word Document 122.0 KB)
- Powered Mobillity Aid Practical Assessment Route Gilles Plains (MS Word Document 157.0 KB)
- Pressure Reduction/Comfort Chair Assessment Form (MS Word Document 413.3 KB)
- Scooter Assessment Form (MS Word Document 54.9 KB)
- Sling Assessment Form (MS Word Document 189.0 KB)
- Wheelchair Initial Assessment Form (MS Word Document 294.5 KB)
Forms - Delegate approval
- Delegate Approval Request Form (MS Word Document 106.3 KB)
Forms - Other
- Client Information Feedback Website Version Form (MS Word Document 78.8 KB)
Forms - Prescriber registration
- Recognition of Prior Learning Assessing and Prescribing Adjustable Beds (MS Word Document 135.0 KB)
Forms - Prescription
- Advanced Palliative Equipment Response Client Registration Form (MS Word Document 88.7 KB)
- Beds checklist’ to Checklist for the Prescription of Electric Beds for APER Clients (MS Word Document 340.4 KB)
- DHS Equipment Program Foot Ankle Orthoses Medical Grade Footwear Request Form (MS Word Document 157.0 KB)
- DHS Equipment Program Wig Request Form (MS Word Document 83.7 KB)
- Equipment Prescription Form ACH (MS Word Document 174.3 KB)
- Equipment Prescription Form ACH Group Electronic Form (PDF 173.5 KB)
- Equipment Prescription Private Hire and External Agencies Form (MS Word Document 82.7 KB)
- Equipment Request Form DHS Equipment Program (MS Word Document 207.5 KB)
- Equipment Request Form NDIS (MS Word Document 75.5 KB)
- Equipment Request Form LSA (MS Word Document 194.8 KB)
- Equipment Request Form RDNS (MS Word Document 146.7 KB)
- Home Modification Request and Agreement Form DHS Equipment Program (MS Word Document 197.6 KB)
- Home Modification Request and Agreement Form LSA (MS Word Document 665.2 KB)
- Imprest Trial and Prescription Form Marla DES Store (MS Word Document 126.0 KB)
- Imprest Trial Record and Prescription Form (MS Word Document 91.1 KB)
Forms - Priority
- Priority Scoring Communication and Assistive Technology (MS Word Document 161.0 KB)
- Risk Rating and Priority Scoring Form (MS Word Document 187.3 KB)
Forms - Repairs / Collections
- Equipment Collection Form ACH Group (MS Word Document 171.1 KB)
- Equipment Collection Request (MS Word Document 161.0 KB)
- Equipment Repair Request Form ACH Group (MS Word Document 173.9 KB)
- Equipment Repair Request (MS Word Document 163.0 KB)
- Equipment Write off Request Form (MS Word Document 116.6 KB)
- Repair Contingency Plan Highly Customised Equipment (MS Word Document 153.0 KB)
Forms - Specifications
- Bidet Specification and Agreement Form (MS Word Document 375.0 KB)
- Ceiling Hoist Specification and Agreement Form (MS Word Document 145.9 KB)
- Childrens Portable Step Specification Form (MS Word Document 185.5 KB)
- Children's Walker Specification Form (MS Word Document 154.0 KB)
- Custom Bed Initial Specification Form (MS Word Document 135.0 KB)
- Customised Chair or Bed Raise Specification Form (MS Word Document 147.5 KB)
- General Seating Initial Specification Form (MS Word Document 1.7 MB)
- Generic Specification Form (MS Word Document 116.5 KB)
- Headrest Position Specification Form (MS Word Document 734.5 KB)
- Home Modification Specification Form Bathroom / Toilet (MS Word Document 144.0 KB)
- Home Modification Specification Form Internal Access Doorway Widening (MS Word Document 121.0 KB)
- Home Modification Specification Form Kitchen (MS Word Document 124.5 KB)
- Home Modification Specification Form Long Ramp (MS Word Document 149.5 KB)
- Home Modification Specification Form Major Step (MS Word Document 118.0 KB)
- Minor Access Home Modification Specification Form (MS Word Document 163.0 KB)
- Minor Home Modification Blank Specification Form (MS Word Document 90.0 KB)
- Mobile Shower Chair Seat Modifications Specification Form (MS Word Document 314.0 KB)
- Scooter Specification Form (MS Word Document 98.1 KB)
- Shower Platform Specification Form (MS Word Document 94.0 KB)
- Standing Frame Initial Specification Form (MS Word Document 153.5 KB)
- Wheelchair Initial Specification Form (MS Word Document 1.7 MB)
Forms - Tracking / Transfer
- Equipment Transfer Update Form ACH (MS Word Document 170.7 KB)
- Equipment Transfer Update Form RDNS or External Agency (MS Word Document 79.1 KB)
- General Equipment and Home Modification Review (MS Word Document 91.5 KB)
- Transferring Ownership of Equipment Items from DCSI Terms and Conditions Agreement Form (MS Word Document 119.0 KB)
- Transferring Ownership of Equipment to DCSI Terms and Conditions Agreement (MS Word Document 145.5 KB)
Maps
- Netley Building 4 Map (MS Word Document 60.0 KB)
- Woodville Site map (MS Word Document 45.5 KB)
Notifications
- Equipment Program Newsletter December 2014 Issue 11 (PDF 279.9 KB)
- Equipment Program Newsletter February 2016 Issue 13 (PDF 250.7 KB)
- Domiciliary Equipment Service Prescriber Update 18 December 2015 (PDF 91.2 KB)
- Equipment Program Newsletter June 2013 Issue 8 (PDF 148.2 KB)
- Equipment Program Newsletter June 2014 Issue 10 (PDF 169.7 KB)
- Equipment Program Newsletter May 2015 Issue 12 (PDF 251.5 KB)
- Equipment Program Newsletter November 2013 Issue 9 (PDF 185.2 KB)
- Equipment Program Newsletter October 2016 Issue 14 (PDF 292.3 KB)
- Equipment Program Prescriber Update December 2014 (MS Word Document 104.1 KB)
- Equipment Program Prescriber Update March 2013 (MS Word Document 151.0 KB)
- Equipment Program Prescriber Update November 2013 (MS Word Document 141.5 KB)
- Equipment Program Prescriber Update September 2015 (PDF 116.4 KB)
Procedures/Guidelines
- Accessing a Wheelchair and Seating Service (MS Word Document 388.5 KB)
- Completing Clinical Review of Equipment (MS Word Document 446.5 KB)
- Completing Follow Up of Equipment (MS Word Document 435.5 KB)
- Completing General Review of Equipment (MS Word Document 341.5 KB)
- Completing Powered Mobility Aid Clinical Review (MS Word Document 409.5 KB)
- Consultant and Clinician Roles in Major Home Modifications (MS Word Document 90.0 KB)
- Funding of Additional Features to Equipment by Client (MS Word Document 393.0 KB)
- How Often Do a Client's Powered Mobility Aid Skills Need Review? (MS Word Document 141.0 KB)
- How to Complete a Prescription Form NDIA (MS Word Document 932.0 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)
- Powered Mobility Frequency of Clinical Review Indicators (MS Word Document 145.0 KB)
- Priority Score Guidelines Adults Equipment (MS Word Document 137.5 KB)
- Transferring Ownership of Equipment Items from DCSI (MS Word Document 361.5 KB)
- Transferring Ownership of Equipment Items to DCSI (MS Word Document 475.0 KB)
- When does a technician and or specialist need to be accessed (MS Word Document 119.5 KB)
Publications
- Home Modification Prescription Agreement Form RDNS CHSP (MS Word Document 193.2 KB)
- Palliative Referrers Communique 29 June 2018 (MS Word Document 318.5 KB)
Reference Documents - Prescription
- Access and Mobility Reference Charts AS1428.1 (MS Word Document 77.4 KB)
- Bathroom Electrical Safety Training Resource Kit (MS Word Document 1.5 MB)
- Bed Entrapment Zone Measuring Tool (MS Word Document 3.0 MB)
- Braden Pressure Risk Scale (PDF 958.4 KB)
- Circulation Spaces at Doorways Appendix C AS1428 1 2001 (MS Word Document 417.7 KB)
- Circulation Spaces at Doorways Fig 1 AS1428 1 2009 (MS Word Document 371.2 KB)
- Cushion Comparison Table (MS Word Document 101.6 KB)
- Electric Adjustable Bed Comparison Table (MS Word Document 451.1 KB)
- Entrapment Zone Compliance Matrix (MS Word Document 79.2 KB)
- Wheelchair comparison chart MWC Type 1 Basic (PDF 190.0 KB)
- Guide to Assessing Entrapment Risk (MS Word Document 122.5 KB)
- Guide to Assessing Pressure Risk Tool (MS Word Document 123.5 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)
- Modifying Equipment Example List. (MS Word Document 93.1 KB)
- ROHO Cell to Seat Size Convert (PDF 514.8 KB)
- Wheelchair and Scooter Panel Range (MS Word Document 102.8 KB)
- Wheelchair and Scooter Supplier Panel Details (MS Word Document 94.0 KB)
Reference Documents – Accessing Services
- DES Payment Options Information (MS Word Document 96.2 KB)
- DES Private Hire Price Guide (PDF 52.9 KB)
- Equipment Item Types and Definitions (MS Word Document 253.0 KB)
- Equipment Supply Suburb Listing for Metropolitan Adelaide (MS Word Document 142.8 KB)
- WSS Information and Process for NDIS Participants (MS Word Document 254.2 KB)
Service Information and Terms and Conditions
- DES AT Training Health Professionals Terms and Conditions (MS Word Document 113.6 KB)
Specific Eligibility Criteria
- Specific Eligibility Criteria Manual Wheelchairs (MS Word Document 153.0 KB)
- Specific Eligibility Criteria Powered Wheelchairs (MS Word Document 172.5 KB)
- Key Approval Criteria for Equipment (MS Word Document 142.0 KB)
- Key Approval Criteria for Home Modifications (MS Word Document 145.0 KB)
- Specific Eligibility Criteria Car Hoist (Person Lift Only) (MS Word Document 152.5 KB)
- Specific Eligibility Criteria Ceiling Hoists (MS Word Document 151.5 KB)
- Specific Eligibility Criteria Electric Beds (MS Word Document 102.0 KB)
- Specific Eligibility Criteria Electric Riser Recliner Chairs (MS Word Document 81.0 KB)
- Specific Eligibility Criteria Eye Gaze Technology (MS Word Document 177.5 KB)
- Specific Eligibility Criteria for the Provision of Wigs (MS Word Document 133.7 KB)
- Specific Eligibility Criteria Long Ramps (MS Word Document 104.5 KB)
- Specific Eligibility Criteria Major Access Modifications (MS Word Document 97.5 KB)
- Specific Eligibility Criteria Major Bathroom Modifications (MS Word Document 101.5 KB)
- Specific Eligibility Criteria Major Kitchen Modifications (MS Word Document 103.0 KB)
- Specific Eligibility Criteria Major Step Modifications (MS Word Document 103.0 KB)
- Specific Eligibility Criteria Modified Driving Controls (MS Word Document 150.5 KB)
- Specific Eligibility Criteria Posture Chairs (MS Word Document 152.5 KB)
- Specific Eligibility Criteria Powered Mobility Aids for Outdoor Use (MS Word Document 163.0 KB)
- Specific Eligibility Criteria Provision of a Powered Mobility Aid and a Manual Wheelchair or Non Standard Stroller (MS Word Document 114.0 KB)
- Specific Eligibility Criteria Rehabilitation Equipment (MS Word Document 151.0 KB)
- Specific Eligibility Criteria Roof Mounted Wheelchair Carriers (MS Word Document 152.5 KB)
- Specific Eligibility Criteria Speech Generating Devices (MS Word Document 149.5 KB)
- Specific Eligibility Criteria Strollers (MS Word Document 148.5 KB)
- Specific Eligibility Criteria Technology (Computer Access) (MS Word Document 154.0 KB)
- Specific Eligibility Criteria Technology (Environmental Control Systems) (MS Word Document 159.0 KB)
- Specific Eligibility Criteria Towbar Mounted Wheelchair Carriers (MS Word Document 158.5 KB)
Template
- Bath Grab Rail Template Left Side (MS Word Document 215.5 KB)
- Bath Grab Rail Template Right Side (MS Word Document 182.5 KB)
- Shower Grab Rail Template (MS Word Document 80.5 KB)
- Toilet Measurements Template (MS Word Document 95.0 KB)
- Toilet Rail Template Left Side (MS Word Document 77.5 KB)
- Toilet Rail Template Right Side (MS Word Document 78.0 KB)
- Toilet Template Front View (MS Word Document 85.5 KB)
Terms and Conditions
- Care and Use of a Powered Mobility Aid (MS Word Document 156.0 KB)
- DES Information for Provision of Home Modifications (MS Word Document 92.9 KB)
- Equipment Program Terms and Conditions of Installation of Home Modifications (MS Word Document 112.6 KB)
- Major Home Modification Client Information Sheet (MS Word Document 139.0 KB)
- Terms and Conditions and Information on Use of Equipment (MS Word Document 141.5 KB)
Prescribing Equipment - by Equipment Type
Prescribing Equipment - by Equipment Type
Allied Health, Safety and Rehabilitation Aids
- Advanced Palliative Equipment Response Assessment Request Form (MS Word Document 183.9 KB)
- Clinical Considerations for Use of Exercise Pedals (MS Word Document 94.0 KB)
- Specific Eligibility Criteria Rehabilitation Equipment (MS Word Document 151.0 KB)
Ambulant Mobility Aids and Accessories
- 4 Wheeled Walkers Fact sheet (MS Word Document 1.8 MB)
- Children's Walker Specification Form (MS Word Document 154.0 KB)
- Crutches Fact Sheet (MS Word Document 148.0 KB)
- Triwalker Fact sheet (MS Word Document 197.0 KB)
- Walkers Clinical Considerations for Prescribers (MS Word Document 137.5 KB)
- Walking Aids Clinical Considertions for Prescribers (MS Word Document 135.5 KB)
- Walking and Quad Sticks Fact Sheet (MS Word Document 295.5 KB)
- Walking Frames Fact Sheet (MS Word Document 261.0 KB)
Bathing Toileting and Continence Aids
- Absorbent Sheet Fact Sheet (MS Word Document 241.0 KB)
- 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)
- Bathboards and Benches Fact Sheet (MS Word Document 337.5 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)
- Childrens Portable Step Specification Form (MS Word Document 185.5 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)
- Mobile Shower Commode Chair Fact Sheet (MS Word Document 295.0 KB)
- Shower Chair and Stools Fact Sheet (MS Word Document 244.5 KB)
- Shower Chairs Clinical Considerations for Prescribers (MS Word Document 200.5 KB)
- Shower Hose Fact Sheet (MS Word Document 162.0 KB)
- Shower Hoses Clinical Considerations for Prescribers (MS Word Document 135.0 KB)
- Toilet Aid Fact Sheet (MS Word Document 301.0 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 Rail Fact Sheet (MS Word Document 1.2 MB)
- Bed Rails Clinical Considerations for Prescribers (MS Word Document 325.5 KB)
- Bed Stick Fact Sheet (MS Word Document 673.0 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 340.4 KB)
- Criteria Screening Tool, Electrically Operated Bed (MS Word Document 100.8 KB)
- Custom Bed Initial Specification Form (MS Word Document 135.0 KB)
- Customised Chair or Bed Raise Specification Form (MS Word Document 147.5 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)
- Self Help Pole Fact Sheet (MS Word Document 168.5 KB)
- Specific Eligibility Criteria Electric Beds (MS Word Document 102.0 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 98.2 KB)
- Criteria Screening Tool, Wheelchair Carrier (MS Word Document 98.9 KB)
- Specific Eligibility Criteria Car Hoist (Person Lift Only) (MS Word Document 152.5 KB)
- Specific Eligibility Criteria Modified Driving Controls (MS Word Document 150.5 KB)
- Specific Eligibility Criteria Roof Mounted Wheelchair Carriers (MS Word Document 152.5 KB)
- Specific Eligibility Criteria Towbar Mounted Wheelchair Carriers (MS Word Document 158.5 KB)
Home Access
- Electronic Door Opener Specification and Agreement Form (MS Word Document 820.7 KB)
- Portable DECPAC Ramp Fact Sheet (MS Word Document 372.5 KB)
Household and Small Aids
- Tray Mobile Fact Sheet (MS Word Document 173.0 KB)
- Traymobile Clinical Considerations for Prescribers (MS Word Document 135.0 KB)
NA
- Home Modification Prescription Agreement Form RDNS CHSP (MS Word Document 193.2 KB)
Person Transfer Aids
- Ceiling Hoist Specification and Agreement Form (MS Word Document 145.9 KB)
- Criteria Screening Tool, Ceiling Hoist (MS Word Document 96.5 KB)
- Hoist Assessment Form (MS Word Document 203.0 KB)
- Hoists Clinical Considerations for Prescribers (MS Word Document 161.0 KB)
- Hoists Fact sheet (MS Word Document 338.5 KB)
- Slide Sheet Fact Sheet (MS Word Document 1.8 MB)
- Sling Assessment Form (MS Word Document 189.0 KB)
- Slings Clinical Considerations for Prescribers (MS Word Document 145.5 KB)
- Slings Fact Sheet (MS Word Document 271.5 KB)
- Specific Eligibility Criteria Ceiling Hoists (MS Word Document 151.5 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 Care Mattresses Fact Sheet (MS Word Document 278.0 KB)
- Pressure Mattresses Clinical Considerations for Prescribers (MS Word Document 156.0 KB)
- Pressure Redistributing Cushions Fact Sheet (MS Word Document 338.5 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)
- WSS Information and Process for NDIS Participants (MS Word Document 254.2 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 156.0 KB)
- Completing Powered Mobility Aid Clinical Review (MS Word Document 409.5 KB)
- Manual Wheelchairs Fact Sheet (MS Word Document 512.0 KB)
- Motor Vehicle Transport of People in Wheelchairs (MS Word Document 163.5 KB)
- Criteria Screening Tool, Scooter (MS Word Document 99.5 KB)
- Customised Chair or Bed Raise Specification Form (MS Word Document 147.5 KB)
- Specific Eligibility Criteria Manual Wheelchairs (MS Word Document 153.0 KB)
- Specific Eligibility Criteria Powered Wheelchairs (MS Word Document 172.5 KB)
- Wheelchair comparison chart MWC Type 1 Basic (PDF 190.0 KB)
- General Seating Initial Specification Form (MS Word Document 1.7 MB)
- Headrest Position Specification Form (MS Word Document 734.5 KB)
- 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 Aid Practical Assessment Route (Woodville Clinic Site) (MS Word Document 88.0 KB)
- 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)
- Powered Mobillity Aid Practical Assessment Route Gilles Plains (MS Word Document 157.0 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 Powered Mobility Aids for Outdoor Use (MS Word Document 163.0 KB)
- Specific Eligibility Criteria Provision of a Powered Mobility Aid and a Manual Wheelchair or Non Standard Stroller (MS Word Document 114.0 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 and Scooter Panel Range (MS Word Document 102.8 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)
- WSS Information and Process for NDIS Participants (MS Word Document 254.2 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)
- Electric Recliner Lift Chair Clinical Considerations for Prescribers (MS Word Document 133.0 KB)
- Criteria Screening Tool, Electric Riser Recliner Chair (MS Word Document 132.0 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 81.0 KB)
- Specific Eligibility Criteria Posture Chairs (MS Word Document 152.5 KB)
- Utility Chairs Clinical Considerations for Prescribers (MS Word Document 136.0 KB)
- WSS Information and Process for NDIS Participants (MS Word Document 254.2 KB)
Splinting, Orthoses and Supports
- DHS Equipment Program Foot Ankle Orthoses Medical Grade Footwear Request Form (MS Word Document 157.0 KB)
- Foot Ankle Orthoses Medical Grade Footwear Assessment Form (MS Word Document 92.0 KB)
Technology, Access and Communication
- Dynamic Client Profile AAC (MS Word Document 90.5 KB)
- Dynamic Client Profile CAT (MS Word Document 100.0 KB)
- Dynamic Client Profile ECS (MS Word Document 100.0 KB)
- Dynamic Client Profile MOUNT (MS Word Document 99.5 KB)
- Specific Eligibility Criteria Eye Gaze Technology (MS Word Document 177.5 KB)
- Specific Eligibility Criteria Speech Generating Devices (MS Word Document 149.5 KB)
- Specific Eligibility Criteria Technology (Computer Access) (MS Word Document 154.0 KB)
- Specific Eligibility Criteria Technology (Environmental Control Systems) (MS Word Document 159.0 KB)
Wigs
- DHS Equipment Program Wig Request Form (MS Word Document 83.7 KB)
- Specific Eligibility Criteria for the Provision of Wigs (MS Word Document 133.7 KB)
Prescribing a Home Modification - by Type
Prescribing a Home Modification - by Type
Access
- Access and Mobility Reference Charts AS1428.1 (MS Word Document 77.4 KB)
- Circulation Spaces at Doorways Appendix C AS1428 1 2001 (MS Word Document 417.7 KB)
- Circulation Spaces at Doorways Fig 1 AS1428 1 2009 (MS Word Document 371.2 KB)
- Electronic Door Opener Specification and Agreement Form (MS Word Document 820.7 KB)
- Home Modification Specification Form Internal Access Doorway Widening (MS Word Document 121.0 KB)
- Minor Access Home Modification Specification Form (MS Word Document 163.0 KB)
- Minor Home Modification Blank Specification Form (MS Word Document 90.0 KB)
- Specific Eligibility Criteria Major Access Modifications (MS Word Document 97.5 KB)
Bathroom
- Applying a Plastic Sheet Over Electrical Outlets Fact Sheet (MS Word Document 154.0 KB)
- Bathroom Clinical Considerations for Prescribers (MS Word Document 162.5 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)
- Bidet Specification and Agreement Form (MS Word Document 375.0 KB)
- Electrical Safety and Bathroom Design Flyer (MS Word Document 109.5 KB)
- Home Modification Specification Form Bathroom / Toilet (MS Word Document 144.0 KB)
- Major Bathroom Modification Assessment Form (MS Word Document 157.5 KB)
- Shower Hose Fact Sheet (MS Word Document 162.0 KB)
- Shower Hoses Clinical Considerations for Prescribers (MS Word Document 135.0 KB)
- Shower Platform Specification Form (MS Word Document 94.0 KB)
- Specific Eligibility Criteria Major Bathroom Modifications (MS Word Document 101.5 KB)
- Toilet Measurements Template (MS Word Document 95.0 KB)
- Toilet Template Front View (MS Word Document 85.5 KB)
Kitchen
- Home Modification Specification Form Kitchen (MS Word Document 124.5 KB)
- Kitchen Clinical Considerations for Prescribers (MS Word Document 148.5 KB)
- Major Kitchen Modification Assessment Form (MS Word Document 126.5 KB)
- Specific Eligibility Criteria Major Kitchen Modifications (MS Word Document 103.0 KB)
Not applicable
Rails
- Bath Grab Rail Template Left Side (MS Word Document 215.5 KB)
- Bath Grab Rail Template Right Side (MS Word Document 182.5 KB)
- Grab Rails Clinical Considerations for Prescribers (MS Word Document 148.5 KB)
- Shower Grab Rail Template (MS Word Document 80.5 KB)
- Toilet Rail Template Left Side (MS Word Document 77.5 KB)
- Toilet Rail Template Right Side (MS Word Document 78.0 KB)
Ramps
- Home Modification Specification Form Long Ramp (MS Word Document 149.5 KB)
- Ramps Clinical Considerations for Prescribers (MS Word Document 156.0 KB)
- Specific Eligibility Criteria Long Ramps (MS Word Document 104.5 KB)
Step Modifications
- Home Modification Specification Form Major Step (MS Word Document 118.0 KB)
- Specific Eligibility Criteria Major Step Modifications (MS Word Document 103.0 KB)
- Steps Clinical Considerations for Prescribers (MS Word Document 146.5 KB)
Approvals
Approvals
- Funding of Additional Features to Equipment by Client (MS Word Document 393.0 KB)
- Transferring Ownership of Equipment Items from DCSI (MS Word Document 361.5 KB)
- Transferring Ownership of Equipment Items from DCSI Terms and Conditions Agreement Form (MS Word Document 119.0 KB)
- Transferring Ownership of Equipment Items to DCSI (MS Word Document 475.0 KB)
- Delegate Approval Request Form (MS Word Document 106.3 KB)
Follow up and Review
Follow up and Review
- Completing Clinical Review of Equipment (MS Word Document 446.5 KB)
- Completing Follow Up of Equipment (MS Word Document 435.5 KB)
- Completing General Review of Equipment (MS Word Document 341.5 KB)
- Completing Powered Mobility Aid Clinical Review (MS Word Document 409.5 KB)
- General Equipment and Home Modification Review (MS Word Document 91.5 KB)
- How Often Do a Client's Powered Mobility Aid Skills Need Review? (MS Word Document 141.0 KB)
- Powered Mobility Frequency of Clinical Review Indicators (MS Word Document 145.0 KB)
Repairs and Maintenance
Repairs and Maintenance
Repairs and Maintenance
- Care and Use of a Powered Mobility Aid (MS Word Document 156.0 KB)
- Equipment Repair Request (MS Word Document 163.0 KB)
Collections and Returns
Collections and Returns
Collections and Returns
- Equipment Collection Form ACH Group (MS Word Document 171.1 KB)
- Equipment Collection Request (MS Word Document 161.0 KB)
Training
Training
Training
- ACTS Lowtech and Static Display AAC Options (MS Word Document 1.6 MB)
- Mounting for Assistive Technology Session Flyer (MS Word Document 1.6 MB)
- Advanced Access Options Session Flyer (MS Word Document 1.6 MB)
- Bathroom Electrical Safety Training Resource Kit (MS Word Document 1.5 MB)
- Beds and Bed Equipment Series Flyer (MS Word Document 112.5 KB)
- DES AT Training Health Professionals Registration and Agreement Form (MS Word Document 58.3 KB)
- DES AT Training Health Professionals Terms and Conditions (MS Word Document 113.6 KB)
- Electrical Safety and Bathroom Design Flyer (MS Word Document 109.5 KB)
- Equipment Program and DES Orientation for External Prescribers Flyer (MS Word Document 177.5 KB)
- Equipment Program and DES Orientation for Internal Prescribers Flyer (MS Word Document 177.0 KB)
- Home Modifications Series Flyer (MS Word Document 114.0 KB)
- Management of the Bariatric Client (MS Word Document 428.5 KB)
- Netley Building 4 Map (MS Word Document 60.0 KB)
- Pressure Injury Prevention Series Flyer (MS Word Document 117.5 KB)
- Recognition of Prior Learning Assessing and Prescribing Adjustable Beds (MS Word Document 135.0 KB)
- Woodville Site map (MS Word Document 45.5 KB)
- The Legal Responsibilities of Equipment Prescription Flyer (MS Word Document 107.5 KB)
- Wheelchair and Seating Series Session 1 Prescribing and Adjusting Manual Wheelchairs (MS Word Document 122.0 KB)
- Wheelchair and Seating Series Session 2 Assessing Capacity in the use of a powered mobility aid (MS Word Document 126.0 KB)
- Wheelchair and Seating Series Session 3 Prescribing and Adjusting Powered Wheelchairs (vA7134986). (MS Word Document 180.0 KB)
- Wheelchair and Seating Series Session 7 Prescribing and Adjusting Powered Wheelchairs Refresher (MS Word Document 107.8 KB)
- Wheelchair and Seating Series Sessions 4 and 5 (MS Word Document 105.5 KB)
Becoming a Prescriber
Becoming a Prescriber
Becoming a Prescriber
- Equipment Type and Prescribing Team Details.xls (XLS 80.5 KB)
Equipment Procedures
Equipment Procedures
Listed here are procedures relevant to prescribing equipment for the Department of Human Services Program.
Equipment
- Funding of Additional Features to Equipment by Client (MS Word Document 393.0 KB)
- Transferring Ownership of Equipment Items from DCSI (MS Word Document 361.5 KB)
- Transferring Ownership of Equipment Items to DCSI (MS Word Document 475.0 KB)
- Completing Clinical Review of Equipment (MS Word Document 446.5 KB)
- Completing Follow Up of Equipment (MS Word Document 435.5 KB)
- Completing General Review of Equipment (MS Word Document 341.5 KB)
- Completing Powered Mobility Aid Clinical Review (MS Word Document 409.5 KB)
- How Often Do a Client's Powered Mobility Aid Skills Need Review? (MS Word Document 141.0 KB)
- Powered Mobility Frequency of Clinical Review Indicators (MS Word Document 145.0 KB)
- Accessing a Wheelchair and Seating Service (MS Word Document 388.5 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)
- Priority Score Guidelines Adults Equipment (MS Word Document 137.5 KB)
- Trialling and Issuing Equipment from Imprest (MS Word Document 461.5 KB)
- When does a technician and or specialist need to be accessed (MS Word Document 119.5 KB)
Approvals
Follow up and Review
Prescribing Equipment
Home Modification Procedures
Home Modification Procedures
Listed here are procedures relevant to prescribing home modifications for the Department for Communities and Social Inclusion Equipment Program.
Eligibility
- Determining Eligibility for Home Modification (DOC 401.5 KB)
Prescribing a Home Modification
- Prescribing a Home Modification (DOC 484.0 KB)
- What are Major and Minor Home Modifications (DOC 125.5 KB)
Approvals
- Accepting Prescriptions from External Clinicians for Home Modifications (DOC 368.0 KB)
- Funding of Additional Home Modification Features by Client (DOC 341.0 KB)
- Seeking Delegate Approval for Home Modifications (DOC 366.5 KB)
Follow up and Review
- Completing Clinical Reviews of Home Modifications (DOC 393.5 KB)
- Completing Follow up of Home Modifications (DOC 445.0 KB)
- Completing General Review of Home Modifications (DOC 327.0 KB)
Repairs and Maintenance
Becoming a Prescriber
Last updated:30 May 2017 3:46pm
State Government of South Australia © Copyright DHS .
Last updated:29 May 2017 4:24pm
The Domiciliary Equipment Service website is licensed
under a Creative Commons Attribution 3.0 Australia
Licence. © Copyright 2016