Clinician Resources
Who to Refer?
While we make an effort to assist every patient that is referred to Aspire Mobility, we do ask clinicians to confirm the following patient criteria before submitting a referral:
- Individual is non-ambulatory and demonstrates unsteady gait.
- Individual is unable to propel a basic manual wheelchair.
- Individual is currently in a wheelchair that does not meet their medical needs.
- Individual is currently in a wheelchair that requires repairs, or is beyond repair.
For Physicians
Custom Wheelchair (Manual/Power) Prescription Form
- Please document in the chart notes the reason for visit as a “Face-to-Face Mobility Evaluation”.
- Please address the following in your progress notes:
- State the purpose of visit as discussing the patient’s mobility needs.
- Discuss how the patient’s mobility is limited by their diagnosis.
- Discuss how the patient’s ADLs are affected by their mobility limitations.
- Discuss the need for mobility assistance to move independently within the patient’s home environment.
- Provide a referral for a therapy evaluation to determine the specific equipment needed for the patient.