TX HHS Form 2362. Receipt Certification by a Qualified Rehabilitation Professional

The TX HHS Form 2362, Receipt Certification by a Qualified Rehabilitation Professional, is used to verify that a customized manual wheelchair (CMWC) meets the needs of a resident in a nursing facility. This form must be completed after delivery and certification of the CMWC and uploaded to the LTC Online Portal.

The key feature of this form is the signature by the qualified rehabilitation professional (QRP), which certifies that they were present and involved in the clinical assessment, and that the CMWC meets the needs of the individual as specified in the assessment. The QRP's signature date must also be accurate and verifiable to avoid requests being placed in pending denial or denied status.

This form is used when a nursing facility receives a customized manual wheelchair for a resident and requires verification that it meets their needs. It is essential to ensure that all information on the form is accurate, as alterations can result in the request being placed into a pending denial status or denied. The TX HHS Form 2362 Receipt Certification by a Qualified Rehabilitation Professional plays a crucial role in ensuring that residents receive the necessary equipment and services.