Health Care Professionals
Assistive Devices Program
Manufacturers/Distributors Application to List New Devices
Respiratory Devices
-
Forms Link
- CPAP/APAP/BPAP Product Evaluation [4509-67]
Mobility – Wheelchairs Positioning(Seating) and Ambulation Aids
-
Forms Link
- Application for Equipment Listing Wheelchairs, Positioning and Ambulation Aids [1819-67]
- Application for Funding of Changes/Modifications/New Options to ADP Approved Devices [3437-67]
- Statement of Support for Device Listing Wheelchairs, Positioning and Ambulation Aids [1903-67]
- Prior Testing Disclosure - Ambulation Aids [4475-67]
- Prior Testing Disclosure - Manual Wheelchair [4473-67]
- Prior Testing Disclosure - Powered Mobility Devices [4474-67]
Insulin Pump and Supplies
-
Forms Link
- Application for Equipment Listing Insulin Pumps and Application for Equipment Listing Insulin Pumps - Checklist [4509-67]
- Insulin Pump Product Evaluation [4508-67]
To view PDF format files, you need to have Adobe Acrobat® Reader installed on your computer. You can download this free software from the Adobe Web site
