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RAP schedule forms
Last updated:
13 October 2020
Here you can find the forms you may need to prescribe an item under the Rehabilitation Appliances Program (RAP).
Forms
Forms are listed in alphabetical order. Guidelines are available to help you prescribe certain items.
Assistive listening devices
Communication devices
See our guidelines page for more information on how to prescribe communication devices
Continence
For more information on how to prescribe continence products see our guidelines:
Essential medical equipment
Apply for an annual payment to help with the energy costs of essential medical equipment.
Exercise bikes
Home modifications
- D1323 - Authority to Install form (PDF 136 KB)
- D1327 - Home / Access Modification Assessment Form for all Major Modifications (bathrooms, ramps, lifts etc...) (PDF 249 KB)
- D9299 - Post home modification report (PDF 300 KB)
See our guidelines page for more information on how to prescribe home modifications
Low vision products (CCTV)
See our guidelines page for more information on how to prescribe CCTV
Mobility & functional support
See our guidelines page for more information on how to prescribe recliner chairs and adjustable electric beds
Oxygen and breathing support
- D0804 - Home medical oxygen therapy and/or respiratory home therapy appliances form (PDF 201 KB)
- D9140 - Application for Positive Airways Pressure (PAP) Equipment(PDF 180 KB)
For more information on how to prescribe see our guidelines:
Personal Response System (PRS)
See our guidelines page for more information on how to prescribe
Assistance Dog - for psychiatric, guide, hearing and mobility dogs
See our guidelines page for more information on how to prescribe
Request / referral for LMO use
Scooters or electric wheelchairs
- D9300 - Scooter / electric wheelchair [Part 1 - medical questionnaire - see also D1325] (PDF 270 KB)
- D1325 - Scooter / electric wheelchair [Part 2 - assessment form - see also D9300] (PDF 380 KB)
See our guidelines page for more information on how to prescribe