Motorised Mobility Devices

Occupational Therapist Resources

Resource name: Discharge letter template – client suitable for MMD use
(Resource 1.6)

Resource purpose: This template letter enables a standardised approach to

reporting that a client has been assessed as suitable for MMD use and has
undergone appropriate education and training.

Resource use: The template can be set up on the OT practice letterhead and/or
incorporated into OT electronic systems as required. It is designed to be used in
conjunction with the GP Report Template (Resource 1.4).

Please note: This resource has been produced by Road Safety Victoria in
collaboration with Austin Health Occupational Therapy Department to support
MMD user road safety and enhance clinical practice (2020).This template can be
modified for use by occupational therapists / health professionals as relevant to
support the care of prospective or current MMD users. Feedback about this
resource can be provided to OTA-Vic.

PLEASE DELETE THIS BOX BEFORE USING THE TEMPLATE

 Occupational Therapist Letterhead

Attention:
Dr [Insert doctor’s name]
[Insert clinic address]
[Insert clinic address]

Date: [ Insert date]

Dear Dr [ Insert doctor’s name]

Discharge report – OT Assessment for use of Motorised Mobility Device (MMD)

PATIENT:
Name: [Insert patient’s name]
Address: [Insert patient’s address]
Date of birth: [Insert patient’s date of birth]
TAC/WorkCover/NDIA/DVA/insurance number: [Insert relevant details]

TYPE OF DEVICE:
[Specify device – powered wheelchair or mobility scooter]

I recently assessed this patient on these dates [insert] to establish their suitability
and capability to operate a motorised mobility device.

[Add details of other circumstances of the referral, for example – new user or
reassessment following incidents or concerns]

The assessment: [Edit the process as appropriate]

The patient has:
 undergone a clinical assessment of their physical and cognitive capacities,
including establishing/reviewing their needs and goals for MMD use
 undergone an on-device assessment to confirm their physical and cognitive
capacity to learn and apply the skills required for safe operation of the
device. This has included specific instruction to address concerns raised.

The findings: [Edit the findings as appropriate]

The patient has:
 demonstrated safe use of the nominated device
 responded to instruction and feedback and demonstrated the ability to
adjust their operation of the device to control it reliably and safely within
intended environments of use.
 Occupational Therapist Letterhead

Conclusion and next steps: [Edit the conclusion as appropriate]

 I conclude that the patient is able to use the device safely at this time.
 [Mention any actions regarding purchase of suitable device and funding
sources to support this]
 [List names of relevant organisations/family/carers who may be
supporting/monitoring safe use]
 In light of [Insert relevant diagnoses e.g. deteriorating medical condition], I
recommend the following in terms of monitoring and review [Add any
recommendations regarding monitoring and review period. List any
resources provided e.g. VicRoads booklet, checklists].

Attached is a summary report of the assessment outcome and recommendations for

your file. Please contact me if you require additional information or wish to discuss
this further.

Kind regards,

[Insert clinician name]

[Insert title]
[Insert organisation]

Cc: [Insert patient’s name]