D9300 - Electric Mobility Aids - Part 1 - Medical Assessment

Form ID
For providers
General Practitioner

This medical assessment form is to be completed by the General Practitioner (GP)/LMO for Rehabilitation Appliances Program (RAP) electric mobility aids (electric mobility scooters, electric wheelchairs, power assist devices and carer-operated wheelchairs).

This is part 1 of a 3-part process (see D1325 for part 2 and D9379 for part 3).

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?
Form file format