Date: Please ask your Doctor or Occupational Therapist to complete Part B of this form. Part B To be completed by your Doctor or Occupational – Therapist Part B Doctor/Occupational Therapist Statement – Eligibility Criteria Criteria 1: The applicant is unable to walk and always requires the use of a wheelchair; or Criteria 2: The ability to walk is severely restricted by a permanent medical condition applicant’s or disability; or Criteria 3: The ability to walk is severely restricted by a temporary medical condition applicant’s or disability. Note below: Only applicants that meet the criteria will be provided with a renewable permit or temporary permit. Temporary permits may be eligible for an extension. Applicants with sensory, cognitive, intellectual or psychiatric impairment alone do not meet the criteria unless they also have a severe walking restriction. The ACROD Parking Program can advise on eligibility for short-term walking restrictions. For further information please request a ‘Health Professional Guide’. How long has the applicant been your patient? State the primary and secondary diagnoses that impact on their ability to applicant’s walk. Please indicate the date of each diagnosis.
Date: Please ask your Doctor or Occupational Therapist to complete Part B of this form. Part B – To be completed by your Doctor or Occupational Therapist Part B – Doctor/Occupational Therapist Statement Eligibility Criteria Criteria 1: The applicant is unable to walk and always requires the use of a wheelchair; or Criteria 2: The applicant’s ability to walk is severely restricted by a permanent medical condition or disability; or Criteria 3: The applicant’s ability to walk is severely restricted by a temporary medical condition or disability. Note below: Only applicants that meet the criteria will be provided with a renewable permit or temporary permit. Temporary permits may be eligible for an extension. Applicants with sensory, cognitive, intellectual or psychiatric impairment alone do not meet the criteria unless they also have a severe walking restriction. The ACROD Parking Program can advise on eligibility for short-term walking restrictions. For further information please request a ‘Health Professional Guide’. How long has the applicant been your patient? State the applicant’s primary and secondary diagnoses that impact on their ability to walk. Please indicate the date of each diagnosis.