Equipment Program

Checklist for giving delegate approval

Home modifications

Check for latest e-version, as photocopies may be out of date: Released XX/XX/XXXX Available from the DCSI EP supporting documents public access list or DCSI Equipment Program site Phone: 1300 295 786 Fax: 1300 295 839 Email: Page 1 of 2

From EP supporting documents public access links list or DCSI Equipment Program site: July 2014

Check for latest e-version, as photocopies may be out of date: Released XX/XX/XXXX Phone: 1300 295 786 Fax: 1300 295 839 Email: Page 1 of 2

Is the requested modification on the Home mods in scope list?
If No, have all possible in scope options been considered with client and found unsuitable?
If this is the only appropriate alternative, forward the request to the Director Domiciliary Care. / Y / N
Y / N
For all other home modification requests:
CompletedInitial Home Modification Prescription Form, including the following responses: / Y / N
Does the requested item meet the Key Approval Criteria for Home Modifications?
Detail required in home visit/assessment report. / Y / N
Domajor modifications (long ramp, step, bathroom, kitchen or access) requests meet specific eligibility criteria? (See EP supportingdocuments public access links list home mods criteria)
Detail required in home visit/assessment report. / Y / N / NA
Does the prescriber have approved prescriber status for the modification or has the prescription been supervised by an approved prescriber? / Y / N
Have all other simpler options been trialled / explored with client?
Detail required in home visit/assessment report. / Y / N
Is the priority rating given appropriate for the client’s needs/situation? / Y / N
Has client been provided with the Terms and Conditions of Installation of Home Modifications and has the client/home owner signed the Initial Home Modification Prescription Form and indicated an understanding of the conditions;
  • DCSI will not fund two major home modifications of the same category within five years
  • Rental properties will be modified if client has secure tenancy of five or more years.
  • Funding will not be provided for features in a new home under construction
  • Client is responsible for any alternative bathing/toileting/housing required during building
/ Y / N

Once decision has been made

  • Approved: Sign Initial Home Modification Prescription Form and return to prescriber
  • Not approved: Prescriber drafts client advice letter for delegate to sign then sends to client and files copy in client file and notes outcome ,delegate and future plan in case notes.

PLEASE NOTE:

If initial approval for cat 2 (project managed) home modification is given, the delegate must also approve/sign scope of works once it is complete

Equipment Program: Telephone:1300 295 786 Fax:1300 295 839 Email:

Check for latest e-version, as photocopies may be out of date: Released XX/XX/XXXX Phone: 1300 295 786 Fax: 1300 295 839 Email: Page 1 of 2