Device to set up Cane or quad cane Walker or rollator Manual wheelchair Scooter or power chair Transfer bench, commode, bed rail, or transfer aid Not sure yet
Why this is being reviewed New device After a fall or near fall After hospital, rehab, or surgery discharge Current device is not working well Planning ahead to age in place
Fit status Not checked by clinician, therapist, or supplier Checked and seems usable Checked but needs adjustment Uncomfortable, unstable, painful, or hard to use
Training status Needs hands-on training Training happened but family is unsure Training happened and feels clear Not sure what training is needed
Home pathway concern No obvious pathway concern Some door, bathroom, rug, cord, step, or clutter concern Major pathway, stair, ramp, or bathroom barrier
Transfer concern Transfers seem manageable Some bed, toilet, shower, chair, or car concern High transfer or lifting concern
Coverage or supplier status Coverage or supplier rules not reviewed Ordered or covered through a plan or supplier Likely self-pay or borrowed equipment Problem, delay, bill, or repair concern Not sure
Caregiver practice status Helper needs practice Helper feels confident Helper is mostly remote No reliable helper yet
Transportation or storage review Not reviewed Transportation and storage seem manageable Car, transit, charging, storage, or doorway problem
Follow-up timing Need a same-day setup checklist Check again within a week Routine monthly or seasonal review Review after fall, near fall, pain, or device problem
Use this to prepare a device-fit and home-use checklist.
Use broad planning answers only. Do not enter names, addresses, Medicare numbers, Social Security numbers, account numbers, diagnoses, prescriptions, claim numbers, or private medical details.
This planner is educational and organizational only. It is not medical, insurance, benefits, legal, tax, construction, or financial advice. Confirm device selection, fitting, training, coverage, supplier rules, home modifications, and safety concerns with qualified professionals and official programs.
Trusted references:
CDC STEADI fall prevention ,
Medicare durable medical equipment coverage ,
Medicare equipment supplier search ,
Eldercare Locator .
