How to Do a Custom Wheelchair Assessment

Why OTPs Should Add Wheelchair Assessments to Their Toolbox

Custom wheelchair evaluations are one of the most underutilized — and most impactful — clinical skills an OTP can offer. Whether you are building an independent practice, picking up contract work, or looking for a specialized side hustle, wheelchair assessments give you a direct path to serving clients who genuinely need your expertise. The documentation you produce is the proof that justifies the equipment, and your clinical reasoning is what gets the chair approved.

This article walks you through the anatomy of a wheelchair assessment note, highlights what stays the same across all chair types, and then breaks down the key differences between a custom manual wheelchair evaluation, a standard power wheelchair evaluation, and a complex power wheelchair evaluation. A fillable template is included at the end so you can hit the ground running.

The Purpose of a Clinical Wheelchair Evaluation

The core purpose of any wheelchair evaluation is to prove medical necessity. An OTP is not technically required to write the evaluation — a descriptive primary care provider note could get a chair covered — but an OTP evaluation tells a far more complete story. It provides context around what the person's daily life looks like, creates an opportunity to test and quantify deficits, and paints the full clinical picture in a way that most PCP visits simply do not have time to do.

The evaluation can happen in a variety of settings. It does not have to be two hours long, in a clinic, with an ATP, or even in person. It could be done during a treatment session, in the home, in acute care, via telehealth, or without the specific wheelchair present. What matters is the quality and completeness of the documentation.

Who Is Involved in the Process

Four key parties participate in the custom wheelchair process, and understanding each role is critical.

Primary Care Provider (PCP): The physician or nurse practitioner leads the process from a medical orders standpoint. They write the prescription, complete the face-to-face encounter, provide documentation in the F2F note, sign the clinical evaluation, and sign the ATP specifications.

Wheelchair Provider Rep: The sales representative connects all the dots from chair request to chair delivered. They communicate with the client, request and collect paperwork, gather signatures, submit to insurance, ensure payment, and schedule delivery.

Wheelchair Provider ATP: The Assistive Technology Professional with the wheelchair company is the expert on the chair itself. They complete all measurements for fit, determine which brands provide the right solution for each component, understand available features matched with insurance reimbursement, and are often mechanically inclined.

OTP (You): You are the expert on the patient's physical limitations and environmental demands. You complete the testing that quantitatively proves the need, gather the history that qualitatively supports the need, and translate ATP jargon into what it means for function.

The Patient: The reason for doing any of this. Their goals for wheelchair use need to be front and center. Managing their expectations and keeping them informed improves adoption of the device.

What Every Wheelchair Evaluation Note Has in Common

Regardless of whether you are writing a note for a manual chair, a standard power chair, or a complex power chair, the documentation structure follows the same framework. Every note should include the following core elements.

Patient Demographics and Evaluation Context

Every note begins with the patient's name, date of birth, date of evaluation, and the type of evaluation being performed (e.g., In Home Wheelchair Evaluation, Telehealth with Video Power Wheelchair Evaluation). Include your practice contact information and the evaluation setting.

Diagnosis and Medical History

Present the patient's primary diagnoses and relevant medical history that contribute to the mobility deficit. This sets up the clinical reasoning for why a wheeled mobility device is needed at all.

Patient Goals Tied to ADLs

State the patient's goal clearly and tie it to functional activities. Every sample note follows the same pattern: the patient's goal is to get an optimally configured [type of chair] to navigate the home and complete ADLs. Then list the specific ADLs — cooking, bathing, toileting, accessing rooms, cleaning, transferring.

Ruling Out Less Restrictive Devices

This is one of the most important sections and appears in every evaluation type. You must systematically explain why each less restrictive device will not work for this patient. The order to address is: cane or walker first, then manual wheelchair (if recommending power), then scooter (if recommending power). For each device, state specifically why it is inappropriate based on the patient's deficits.

Objective Data

Every note includes quantifiable assessment data. The common measures across all chair types include: Functional Reach Test (with fall risk interpretation), MAHC Fall Score, upper extremity strength (manual muscle testing), and active or passive range of motion of the upper extremities.

Depending on the patient presentation, you may also include: Borg Dyspnea Scale, Braden Score (pressure sore risk), Modified Ashworth Scale (tone), pain scales, and edema measurements.

Equipment Justification with Clinical Reasoning

For every component or feature of the recommended chair, you must explain why that specific feature is needed and link it back to the patient's deficits and functional goals. This is where the note moves beyond checkboxes and into the clinical storytelling that gets equipment approved.

Patient Capability and Willingness Statement

Every note includes a statement that the patient has the physical and mental capabilities along with the willingness to use the device. If the patient has prior experience with the same type of device, note that as well.

Financial Disclosure

Include a statement disclosing that you have no financial ties to the wheelchair provider company (e.g., NuMotion, Rehab Medical).

Occupational Therapy Plan

Every note closes with a follow-up plan specifying the number of visits needed after delivery for ADL training with the new device, along with measurable goals.

Signature Block

Your signature, credentials, date, and time of the evaluation. A line for the PCP to co-sign and concur with findings.

What Changes Between the Three Chair Types

While the framework stays the same, the depth of objective data, the complexity of clinical reasoning, and the number of components requiring justification increase significantly as you move from manual to standard power to complex power.

Custom Manual Wheelchair (K0005 Ultra Lightweight)

Typical patient profile: A patient who has the upper extremity strength and coordination to self-propel but needs a custom-fit frame for optimal ergonomics. Often presents with chronic pain, limited activity tolerance, fall risk, and may have comorbidities like DM II or COPD.

Key documentation differences:

The note focuses on why a standard or lightweight manual wheelchair is inappropriate — usually due to weight and size. A custom-fit chair is required for optimal self-propulsion without exacerbating existing pain or overuse injuries. You need to justify the K5 ultra lightweight classification specifically.

Axle adjustability is a major documentation point. You must link it to the patient's specific shoulder ROM limitations and explain how adjustable axle position optimally configures the chair for the most effective propulsion pattern while protecting limited joint range.

Component justification tends to include: custom width, height, and depth for fit; removable wheels for transport; anti-tippers for safety; height-adjustable armrests for transfers; general use cushion for skin protection; heel loops; tire type (e.g., full poly to reduce maintenance); and seat belt for positioning.

Objective data emphasis: Shoulder flexion and abduction ROM (specific degrees), pain at rest vs. with activity, Functional Reach, fall history, and activity tolerance.

Standard Power Wheelchair (Group 2)

Typical patient profile: A patient who cannot self-propel a manual wheelchair due to limited UE strength but does not require complex positioning features. Often presents with chronic pain, limited standing tolerance (less than 1 minute), high fall risk, and multiple comorbidities.

Key documentation differences:

The ruling-out section must address why a manual wheelchair will not work (UE strength too limited to propel, weight of chair too heavy) in addition to why a cane, walker, and scooter are inappropriate. The scooter is typically ruled out due to lack of back and trunk support needed for pain management and poor turning radius for in-home use.

Standard power chairs are classified as Group 2 and can include up to 2 of the following 3 features: elevating leg rests, tilt, or recline. The note needs to justify why power function is required for independent mobility.

Component justification is typically simpler than complex power — headrest, headrest hardware (removable for transfers), joystick placement (specify side and why), and batteries.

Objective data emphasis: Bilateral UE strength, shoulder ROM, functional tests (Functional Reach, MAHC Fall Score), and standing tolerance.

Complex Power Wheelchair (Group 3)

Typical patient profile: A patient with significant neurological involvement, asymmetric deficits (e.g., hemiparesis from CVA), high tone, contractures, pressure sore risk, and edema. Often has extensive surgical history and requires multiple power seating functions.

Key documentation differences:

This is the most documentation-intensive evaluation. The ruling-out section addresses the full spectrum — cane, walker, manual wheelchair, and scooter — with detailed clinical reasoning for each.

The objective data section is the most robust, often including: Borg Dyspnea Scale, Braden Score, Functional Reach, MAHC Fall Score, Modified Ashworth Scale (with specific tone grading), pain location and severity, edema measurements and grading (bilateral), detailed passive and active ROM at multiple joints (shoulder, elbow, fingers), and detailed strength testing (bilateral, grip, extension).

Complex power chairs are Group 3 and can accommodate more than 2 power seating functions. The component justification section is extensive and must individually address: tilt (for pressure relief, positioning, circulation, pain management, line of sight), recline, headrest and headrest hardware, swing-away joystick (specify side, why relocated), pressure-relieving cushion, positioning back cushion, lateral supports (for midline positioning), batteries, wiring harness, electronics, expandable controller (to run power functions through the joystick), and foot plate.

Each component must be tied back to a specific deficit. For example, tilt is needed because the patient cannot perform functional weight shifting due to poor RUE and RLE strength, is at high risk for skin breakdown, and needs to manage back pain and LE edema.

Objective data emphasis: Extensive bilateral measurements, tone assessment, passive vs. active ROM differentiation, edema grading, pressure sore risk scoring, and dyspnea.

Custom Wheelchair Assessment Examples

Have questions about building wheelchair evaluations into your practice? Drop in to Office Hours for specific help.