• Why are the prescription details required for a prescribed device?
• How shall I ensure the prescription details provided are understood by all parties? Is there a glossary of terms indicating how each detail is determined/measured?
• How do I make changes or corrections on an ADP application form that has been approved by the Program?
• I have mailed an application to the ADP without listing all the prescription details and ADP device codes. What should I do?
• How do I get a blank copy of the Application for Mobility Devices form?
• Is a French version of the application form available?
• Does the application form have a pre-assigned number?
• How do I know which pages of the form to complete and send to the ADP?
• What boxes do I need to check on the form to make sure that funding is approved for my client?
• Can I insert the ADP device codes beside the boxes that I have to check for the prescription details?
• My client is currently in hospital awaiting placement in a long-term care home. He/she has given up his/her home and has no permanent address. What address can I use on page 1 of the form?
• I feel responsible for the application form and do not feel comfortable having my client or the vendor submit it to the ADP. What should I do?
• I am an ADP Registered Authorizer. Do I have to fill out the section on the form for “Non ADP Options Prescribed”?
• What sort of items would I put in “Non ADP Options Prescribed”?
• Do I have to fill out the section on the form for “Set Up Instructions for Vendor”?
• What sort of items would I put in “Set Up Instructions for Vendor”?
• I authorize standing frames for children. Do I have to provide a detailed prescription on page 2?
• I did not know that my client was receiving social assistance benefits when I submitted the application to the ADP. What can I do?

The Prescription Details section is required to allow the ADP registered authorizer to focus on the clinical needs of their client and not on the ADP device codes. When the form is completed it provides the vendor with a comprehensive prescription from which to dispense the equipment.

The prescription details and definitions of those details are not determined by the ADP and therefore a glossary of terms is not available. In order to ensure that all parties understand the prescription, it is suggested that the authorizer and the vendor meet prior to the completion of the form to discuss the prescription and set-up of the equipment. In addition it should be noted that the application form includes a section entitled, “Set Up Instructions for Vendor”, where the authorizer may include more detailed requirements of the equipment.

Authorizers must make the correction on the appropriate page of the application form and submit it by fax (416-327-8192) or mail, with a covering page explaining why the change(s) are required. Do not send in a new application form.

Fax a written request to the attention of the Mobility Category Program Coordinator at 416-327-8192 outlining the additions. Make sure to include your client's name and health card number on the request.

You may download the form from this website or request a copy from the ADP to photocopy as required.

Yes, a French version of the new form will be available both on line and from the ADP directly if requested.

No. Once an application form arrives at the ADP and has been data entered into the computer system, a unique ADP number will be assigned. The number will appear on the authorizer and vendor Status of Applications Reports and all subsequent correspondence regarding the application.

You must always send page 1 and page 6. Complete page 2, 3, 4 and/or 5 depending on the type of device you have authorized. Make sure you staple all the pages together before mailing it to ADP. Only send the pages that are required for the equipment that you have authorized.

For example:

• if you have authorized a wheeled walker submit page 1, 2 and 6.
• If you have authorized a wheeled walker, a manual wheelchair and seating submit pages 1, 2, 3, 5 and 6.
• If you are replacing or adding seating to a wheelchair, submit pages 1, 5 and 6.

You must complete your clinical assessment and confirm eligibility for ADP funding using the Administration Manual before you complete the application form. Just answer the questions based on your clinical findings. The ADP will match answers to eligibility requirements. Please note that some of the questions are for statistical purposes only and are not reviewed as part of the confirmation of eligibility.

No. The ADP computer will generate the codes and corresponding funding dollars based on the boxes you check. Do not change or add to the spaces and boxes provided on any of the pages.

You may use the address of his legal agent as long as it is an Ontario address or if not applicable, use the hospital’s address.

It is not your direct responsibility. Discuss your concerns with your client and the vendor and come to a mutually agreed upon process. It is the client’s decision as to who mails the application form to the ADP.

No. The space is provided for you and the vendor to use as you wish. It has no impact on funding.

Any options that you may recommend and/or your client would like to add to the authorized device that are either not funded by the ADP, e.g. slow down brakes, baskets and trays for wheeled walkers or for which your client does not meet ADP eligibility criteria, e.g. a specialty headrest only required for transportation, a tray needed only for meals.

No. The space is provided for you and the vendor to use as you wish. It has no impact on funding.

Directions regarding wheel camber, axel placement, angle of seat belts, placement of lateral supports etc.

No. Just check off box #6 on page 2 of the application form.

Your client will have to provide proof that he/she was receiving benefits on the assessment date (the date the form was signed). Mail or fax (416-327-8192) a copy of his/her cheque stub directly to the Mobility Category Program Coordinator.

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