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:

  • 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.

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