Approved by: Robert Lagaida / Version: 02 / Office use only
Modified: 18 Aug 2010 / Published:25 Aug 2010
Area Health Service/Organisation *
GSAHS
GWAHS
HNEAHS / HSS
NCAHS
SWAHS / NSCCAHS SESIAHS
SSWAHS / CHW
Other
EnableNSW provides access to funding for the provision of assistive technology to eligible NSW residents with a permanent or long term disability.
This form is to be used when applying for assistance from an EnableNSW program:
- Program of Appliances for Disabled People (PADP)
-Specialised Equipment Essential for Discharge (SEED) program
- Home Respiratory Program, comprising
-Home Oxygen Service (HOS)
-Children’s Home Ventilation Program (CHVP)
-Adult Home Ventilation Program (AHVP)
- Artificial Limb Service
Instructions
- An Application Form needs to be completed by the applicant or their representative the first time an application is made to EnableNSW or if it is greater than 12 months since the applicant last received assistance from EnableNSW.
- This form provides personal and demographic information and details of the applicant’s disability and is the basis for determining eligibility.
- This form is to be submitted in conjunction with an Equipment Request Form, which must be completed by an eligible prescriber.
- The Equipment Request Form provides information regarding the assessment process and reasons for recommendation of the assistive technology.
- The application will be processed when both a current Application Form and an Equipment Request Form have been received.
Checklist:
all sections completed
declaration in section 7 signed by the applicant or their representative
copy of Medicare card attached
copy of Pension card attached (if applicable)
copy of Australian Taxation Office assessment noticeattached (if applicable)
Equipment Request Form completed by an eligible prescriber attached
For further information or assistance:
Telephone: 1800 ENABLE (1800 362 253)
Email:
Website:
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