Purpose of this document
This summary sets out the clinical evidence gathered to demonstrate that an assistive technology or home modification need exists, and what funding is required to address it. It supports a Registered Provider or aged care assessor to make a funding decision. It is not a prescription.
 
Use it when
The participant has no current AT or HM approval.
The current approval or tier is insufficient, and the solution has not yet been finalised.
There is not enough funding to complete further assessment, trials, obtain technical input, finalise specifications and/or obtain a formal quote. 
The OT can identify the likely type and estimated cost of the solutions but cannot yet prescribe a final item or modification.
 
Do not use it when
The OT has completed the assessment needed to recommend a defined item or modification. Use the ‘AT/HM Prescription’ instead.
Sufficient funding is already available/approved and the provider requires a prescription.
An initial assessment has not yet been complete to determine needs stated in this form.
 
How to use it 
This template provides a concise summary of the clinical evidence supporting a request for additional AT and/or HM funding before specific solutions can be trialled and prescribed.
It captures the essential information required to explain the participant’s needs, anticipated supports and likely funding requirements while supporting defensible documentation. It is not intended to replace a final prescription once trials and assessment have been completed.
Dropdown fields are included to support efficient completion.
Instructional text marked [ ] and highlighted as well as grey example text is for guidance and should be deleted before use finalising as a PDF .
 
Why use this template
While an initial OT report may provide sufficient evidence and can still be submitted where it clearly identifies the participant’s AT/HM needs and anticipated funding requirements; this optional template is useful when the initial report is lengthy, does not clearly state the funding decision being requested, or contains clinical information that is not relevant to the provider or assessor. It brings the key evidence together in a concise format and may be embedded within the initial report or used as an extractable summary. It is not intended to duplicate information already documented or replace a final prescription once assessment and trials have been completed.