Manitoba's Disability and Health Supports Unit (DHSU) uses this form to fund wheelchair seating components, such as cushions, backrests and secondary positioning parts, for people in Employment and Income Assistance, Manitoba Supports for Persons with Disabilities, Children's disABILITY Services or Community Living disABILITY Services. The therapist assesses the client, trials products from an authorized vendor and submits the final prescription with the vendor's quote.
An occupational therapist or physiotherapist licensed to practise in Manitoba completes the whole form as the prescriber. The selected authorized vendor supplies the trial equipment and an itemized quote for the final prescription.
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Wheelchair Seating Component Request and Justification Form
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Only an occupational therapist or physiotherapist licensed to practise in Manitoba. DHSU's seating manual makes the prescriber responsible for the assessment, choosing a vendor from the Wheelchair Seating Component Equipment List, arranging the trial, submitting the form with the quote, following up with the client and signing off the vendor's invoice.
DHSU notifies the client and the prescriber of the outcome. If the request is approved, the equipment is ordered through MDA, which issues a purchase order to the selected vendor. The vendor supplies only what is approved and invoices MDA after the prescriber signs off the completed work.
DHSU's form guide calls the product trial crucial for showing that the targeted outcomes are achieved. Section 8 records each product trialled, whether the trial succeeded and the outcome, and the prescriber must give a reason if nothing was trialled. Custom modifications need a clinical rationale in Section 9.