D1327 – Complex Home/Access Modifications
How can I access this form?
na
Form file format
Download as PDF (393.9 KB)
Form ID
D1327
Audience
For providers
Occupational therapist (general)

This form is to be used for the following Rehabilitation Appliances Program (RAP) complex home/access modifications:

  • AL05 – Stair Lift
  • AL07 – Vertical Platform Lifts
  • AL10 – Ramps > 190mm
  • AL14 – Step > 2 steps
  • AL15 – Bathroom
  • AL23 – Stove Isolation Switch
  • AL26 – Ramp Demountable
  • AL28 – Other Room
  • AM04 – Ceiling Hoist
  • AZ03 – Shower Seat – Fold Down
  • BE01 – Bidet
  • BE12 – Bidet RPZ Value

If you are using an Apple computer and want to fill out your form electronically, please download the form and open it with Acrobat 7 or later.