D1327 - Complex Home/Access Modifications

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:

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

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.

How can I access this form?
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Form (PDF or Word)