Minor Home Modification Proformas
The NSW HMMS State Council’s Occupational Therapist Reference Group have developed a range of resources as part of the NSW HMMS State Council’s Occupational Therapy Program.
The following proformas and forms for home modifications are now available and can be downloaded as both hard and active copies.
Minor Home Modification Proformas
Prescribing Grabrails
Prescribing a Hand Held Shower Hose
These proformas and forms can also be utilised for referrals to other home modification service providers such as DVA and Housing NSW, depending on the local requirements of such organisations.
To ensure you can use the forms with ease we recommend that you download the free Adobe Reader X (10.0.1) software which requires no licensing agreements. Please go to the following link to download http://get.adobe.com/reader/
Hints & Tips for using the Forms & Proformas Click
ACTIVE Copies
Active Copies can be completed and email or fax.
Standard grabrails (angled, vertical, horizontal) should be prescribed whenever possible as combined grabrails (horizontal & angled and hoizontal & vertical) are expensive and are not always structurally feasible.
Toilet: Grabrail LEFT hand side when seated
Toilet: Grabrail RIGHT hand side when seated
HARD Copies
These copies are to be printed and completed onsite.
Standard grabrails (angled, vertical, horizontal) should be prescribed whenever possible as combined grabrails (horizontal & angled and hoizontal & vertical) are expensive and are not always structurally feasible.
Toilet: Grabrail LEFT hand side when seated
Toilet: Grabrail RIGHT hand side when seated
ACTIVE Copies
Shower 1 Shower 2 Shower 3
ACTIVE Copies
Shower Recess:
Shower Recess:
Shower Recess:
Shower Recess:
HARD Copies
Shower Recess:
Shower Recess:
Shower Recess:
Shower Recess:
ACTIVE Copies
Bath 1 - Left Bath 2 - Right
Bath:
Bath:
Bath:
HARD Copies
Bath:
Bath:
Bath:
