Assistive Technology Checklist

Technical Advisory Team - DOCUMENT 2

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The contents of this document are OFFICIAL

Participant Name: Click or tap here to enter text. CRM Number: Click or tap here to enter text. Delegate Name and UserID: Click or tap here to enter text. Date: Click or tap here to enter text.

Instructions

Refer to the fact sheet Understand Assistive Technology Evidence Advice Assessments And Quotes in order to assist you in determining the level of supporting documentation you may require to progress an assistive technology decision.
Refer to the PANDA AT Item Budget Tool to assist you determine the benchmark cost for the Assistive Technology in the absence of pricing evidence (quote).
Complete the checklist sections below related to Mid cost or High cost recommended Assistive Technology.
If any item is marked “no” and further information is required, please obtain this from the participant/assessor.
If all items are marked “yes”, please:
- review non mandatory TAB requests for a decision or discuss with your Team Leader or Assistant Director for assistance in determining your decision;
- if TAB advice is still required or AT is a mandatory TAB request, follow the process on the Requesting Advice page to submit a TAB request.
The completed checklist should be uploaded together with documents relevant to the request, to inbound documents in CRM.

References:

NDIS Act 2013 Section 34 1. (a) - (f) and 2.
NDIS Support for Participant Rules 2013
Assistive Technology Operational Guideline

Mid Cost Assistive Technology ($1500 - $15000)

Attach written evidence from an assistive technology advisor.
Attach any pricing evidence that may have been supplied or AT Item Budget Tool (Note: a quote is not required for mid-cost Assistive Technology).

1. How will the item help the participant with their disability support needs?

This may include details regarding the participant’s current function, current difficulties encountered due to their disability and how the item will assist them.

Requestor opinion: Click or tap here to enter text.

File location: DIA 17/3330 OFFICIAL Page 1 of 4 Issued: 2018

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Is the item deemed the best value way to help the participant pursue their plan goals? Why?

This may include alternative AT options considered by the Assessor, including lower cost comparable supports and reasons why these options were discounted. This may refer to the participant’s current AT and supports used, participant’s lived experience with AT alternatives and any trials undertaken already. It may also provide information about long term benefits of the proposed AT e.g. anticipated growth, or expected changes to the participant’s circumstances or functioning in the next 1-2 years.

Requestor opinion: Click or tap here to enter text.

How much the item may cost:

Note: Agency guidance highlights a quotation is not required for a mid-cost AT item however the AT Advisor may have provided some information to inform this.

Requestor opinion: Click or tap here to enter text.

High-Cost Assistive Technology (> $15 000)

O Attach the recommending Assessor / Health Professionals Assessment

(N.B. If this level of Assistive Technology is requested, written advice from the Assessor is unlikely to include sufficient information to make a reasonable and necessary determination and the Assessor should be encouraged to complete the NDIS Assistive Technology Assessment Template)

| Items | |—|—| | Has a comprehensive assistive technology assessment report been completed and with the following details included: | Choose an item. | | Participant’s current function as observed in the assessment; e.g. mobility/transfers/self-care/communication skills (including potential for skill development). | Choose an item. | | Participant’s existing assistive technology (AT) and supports used e.g. if requesting funding for a new Brailler, other technology that the participant already has such as a computer, mobile phone, older model Brailler etc. | Choose an item. | | AT that is being requested to be replaced if applicable, including why, as well as age; condition; repair history from a repairer including a report stating the current support is in a condition beyond repair. | Choose an item. |

File location: DIA 17/3330 OFFICIAL

Issued: 2018 Document Version No: 4 Date last review: 28/02/2022

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Items	Yes/No	Further Information Required
All alternative assistive technology options considered by the Assessor, including lower cost comparable supports and clinical reasons why these options were discounted.	Choose an item.
Clinical justification for each key feature of the proposed AT support.	Choose an item.
AT trials undertaken with the participant, including where the trials occurred, for how long, and functional outcomes observed during the trials. If no AT was trialled, clinical justification as to why this did not occur.	Choose an item.
Compatibility of the proposed AT support with the participant’s environment, other assistive technology the participant uses and the carers ability to use the AT if it is indicated that assistance will be required e.g. can the support be transported in the participant’s vehicle if applicable; can it be used within the participant’s home/school/community.	Choose an item.
Consideration of the participant’s future AT needs and long term benefits of the proposed AT e.g. anticipated growth, adequate justification for the requirement of a larger vocabulary in communication devices, expected changes to the participant’s circumstances or functioning in the next 1-2 years.	Choose an item.

Attach itemised quote received for the AT funding request

Items	Yes/No	Further Information Required
Quote should itemise cost of each feature that is not within the standard level features for the AT support	Choose an item.
(e.g. for a power wheelchair this should include cost itemisation of the seating components, powered functions/actuators such as tilt in space, power elevating leg rests, vertical seat raise, recline and standing functions etc.)

Document Control

File location: DIA 17/3330 OFFICIAL

Issued: 2018 Document Version No: 4 Date last review: 28/02/2022

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