Ontario Ministry of Health and Long-Term Care - Providers Information - Programs - Assisstive Devices - Newsletters - Newsletter December 2002

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Assistive Devices Program

Required Signatures

Can I fax the form to the power of attorney to be signed and have it faxed back to me?
My client requires two different devices. I will be authorizing a wheeled walker and another ADP Registered Authorizer will be authorizing a wheelchair. Can we both sign one application form?
Who has to sign the application form?
My client’s power of attorney lives in the USA. Can his friend sign on his behalf?
When do I have to have my client’s signature witnessed?
Can I or the vendor sign as the witness?
When do I need to submit a signed consent for release of information to the ADP?
How can I obtain the vendor’s signature if they are not at the assessment?
My client needs to use vendor “A” to dispense his wheelchair and vendor “B” is providing the custom seating. Which vendor signs the ADP form?
When should I (the vendor) sign the application form?

Can I fax the form to the power of attorney to be signed and have it faxed back to me?

No. The ADP requires the original signature of all signers - client/agent, authorizer and vendor.

My client requires two different devices. I will be authorizing a wheeled walker and another ADP Registered Authorizer will be authorizing a wheelchair. Can we both sign one application form?

No. Each of you will have to complete a separate form for the particular device that you have authorized personally. You do not need to mention the other form that is being submitted. The ADP computer system will cross reference the two requests.

Who has to sign the application form?

The client or agent, the ADP Registered Authorizer and the ADP Registered Vendor all must sign the form before it is submitted to the ADP.

My client’s power of attorney lives in the USA. Can his friend sign on his behalf?

No. Only a person legally authorized to sign on the individual’s behalf may sign the form. The form will have to be mailed to the power of attorney for signature and returned to you by mail as soon as original signatures are required.

Note : See the Administration Manual and the Program Manual Section 115.01 for definitions of Agent

When do I have to have my client’s signature witnessed?

Your client’s signature must be witnessed only when he/she signs with an X or similar sign.

Can I or the vendor sign as the witness?

No. The witness must be someone who knows the client, but not the authorizer or vendor.

When do I need to submit a signed consent for release of information to the ADP?

When you and/or your client want information about previous ADP funding and a current application is not in the ADP system.

How can I obtain the vendor’s signature if they are not at the assessment?

The vendor may sign the form when they deliver the trial equipment to the client.

My client needs to use vendor “A” to dispense his wheelchair and vendor “B” is providing the custom seating. Which vendor signs the ADP form?

Both vendors should sign the application. There is room for two vendors on page 6 of the form.

Note : This does not apply to clients of the Central Equipment Pool for High Technology Wheelchairs. See Section 6 of the Administration Manual for further details.

When should I (the vendor) sign the application form?

You may sign the application form anytime after the client informs you that you are the vendor of choice.



Call the Assistive Devices Program at 1-800-268-6021 (Toll-free in Ontario only) In Toronto, call 416-327-8804 TTY 1-800-387-5559

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