TX HHS Form 3706. Nursing Facility Customized Power Wheelchair (CPWC) Authorization

The TX HHS Form 3706, Nursing Facility Customized Power Wheelchair (CPWC) Authorization, is a crucial document for healthcare professionals to authorize the use of customized power wheelchairs in nursing facilities. This form helps solve the problem of ensuring that residents receive the necessary equipment and support for their mobility needs.

This form should be used when a resident requires a customized power wheelchair (CPWC) and the nursing facility needs to obtain authorization from the relevant authorities. The form is divided into several sections, including Resident-Related Identifying Information, Nursing Facility Identifying Information, Therapist Identifying Information and CPWC Assessment, and other important details. Key features of this form include required information such as resident's name, Medicaid number, date of birth, and nursing facility address.

This form is particularly useful in scenarios where a resident needs to transfer their authorization for a CPWC to a new facility. In these situations, only Sections A, B, F, and G need to be completed and submitted. The form also highlights the importance of neurological factors in determining the resident's muscle tone and assessing their active and passive movements affected by this tone.