Forms and documents
The Alberta Aids to Daily Living (AADL) forms and information are sorted by topic.
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Authorizer forms
- Authorizer Application (PDF, 141 KB)
- Burn Garments Authorizer Application (PDF, 133 KB)
- Compression Garments Authorizer Application (PDF, 134 KB)
- Incontinence Supplies Authorizer Application (PDF, 116 KB)
- Interactive Voice Response Authorizer Guide (PDF, 148 KB)
- Seating Secure Website Application
- Seating Authorizer Application – Level B & C (PDF, 138 KB)
- Speech Generating Communication Devices Authorizer Application (PDF, 103 KB)
- Manual Wheelchair and Seating (Level A) Authorizer Application (PDF, 131 KB)
- Power Wheelchair Authorizer Application (PDF, 128 KB)
Bathing, toileting, homecare equipment, transfer aids
- Assessment Summary for Bathlift Benefit (PDF, 136 KB)
Footwear forms
- Custom Footwear Validation Certificate (PDF, 117 KB)
- Custom Made Footwear Client Documentation (PDF, 159 KB)
- Custom Made Footwear Document A (PDF, 135 KB)
- Custom Made Footwear Document B (PDF, 180 KB)
- Custom Made Footwear New Client Questionnaire (PDF, 164 KB)
- Therapeutic Footwear Prescription form (PDF, 100 KB)
General forms
- Client Declaration form (PDF, 153 KB)
- Change of Vendor Request (PDF, 150 KB)
- Order AADL forms and brochures (PDF, 126 KB)
- Trial Equipment Use Guidelines (PDF, 22 KB)
- Advanced Quantities of Medical Surgical Supplies Request (PDF, 155 KB)
- Authorization Correction and Change form
- Complaint form
- Cost-Share Exemption Notice of Appeal
- Application for Cost-Share Exemption (PDF 144 KB)
- Application for Temporary Cost-Share Exemption
- Manual Claim Form for Approved COVID-19 Cost-Share Extensions (PDF, 183 KB)
Hearing aid forms
- Audiogram History (PDF, 317 KB)
- FM / DM Service Certificate (PDF, 156 KB)
- Repair / Earmold Service Certificate (PDF, 155 KB)
- Amplification Benefits Validation Certificate (PDF, 156 KB)
- External Cochlear Implant Processor Receipt of Equipment Acknowledgement (PDF, 155 KB)
- Bone Anchored Hearing Device (BAHD) Receipt of Equipment Acknowledgement (PDF, 155 KB)
- Hearing Aid Benefit Cost-Share Exemption Application for Seniors and Their Adult Dependents (PDF, 106 KB)
Medical-surgical forms and assessment tools
- Assessment Summary for Incontinence Products (PDF, 211 KB)
- Bladder Irritants (PDF, 45 KB)
- Braden Pressure Ulcer Risk Assessment Tool (PDF, 21 KB)
- Breast Prosthesis Fitter’s Specialty Suppliers form (PDF, 141 KB)
- Fitting form – Lower / Stocking (PDF, 146 KB)
- Fitting form – Upper Extremity (PDF, 267 KB)
- Fluid Management in Children (PDF, 11 KB)
- Incontinence Supports Locations (PDF, 132 KB)
- Incontinence Product List
- Injection Supply Request form (PDF, 149 KB)
- Lower Leg Assessment (Compression Stocking) form (PDF, 155 KB)
- Toilet Training Readiness Assessment Tool (PDF, 15 KB)
- Toilet Training Strategies (PDF, 23 KB)
Pediatric equipment forms
- Assessment Summary for Pediatric Standing Frame Benefits (PDF, 111 KB)
Prosthetic, orthotic forms
- Orthotic / Prosthetics Calculator (XLSX, 25 KB)
- Prosthetic and Orthotic Device Validation Certificate (PDF, 144 KB)
- Prosthetics and Orthotics Fee Guide Addition (PDF, 174 KB)
- Prosthetics Microprocessor Knee Client Declaration (PDF, 174 KB)
Quantity and Frequency Review request forms
- QFR Appeal to Director (PDF, 184 KB)
- QFR Checklist (PDF, 130 KB)
- QFR Request form
Respiratory forms
- Client Declaration Respiratory form (PDF, 149 KB)
- Home Ventilator Funding form (PDF, 155 KB)
- Respiratory Provider forms – Alberta Blue Cross
Seating and wheelchair accessories forms
- Seating Assessment form (PDF, 167 KB)
- Seating Assessment Instructions (PDF, 152 KB)
- Seating Benefits Screening (PDF, 120 KB)
- Seating Technician Application (PDF, 121 KB)
Speech generating communication devices forms and resources
- Speech Generating Communication Device Benefit Information Sheet (PDF, 94 KB)
- Speech Generating Communication Devices Service Centre Application (PDF, 161 KB)
- Speech Generating Communication Devices Service Centres (PDF, 115 KB)
Vendor, specialty supplier forms
- Specialty Assessor Application (PDF, 140 KB)
- Vendor Application (PDF, 133 KB)
- Vendor Interactive Voice Response Guide (PDF, 370 KB)
- Vendor Secure Website Application (PDF, 72 KB)
Wheelchair forms
- Generic Codes for Wheelchair Application (PDF, 195 KB)
- Client Declaration – Category A, B or D Upgrade Wheelchair (PDF, 79 KB)
- Exclusion List - Manual and Power Wheelchairs (PDF, 28 KB)
- Manual Adult Tilt-in-Space Wheelchair Request (PDF, 136 KB)
- Manual Wheelchair Benefits Eligibility Summary (PDF, 133 KB)
- Manual Wheelchair Replacement Request (PDF, 160 KB)
- Manual Pediatric Tilt-in-Space Wheelchair Request (PDF, 137 KB)
- Power Mobility Application (PDF, 167 KB)
- Power Mobility Application information (PDF, 52 KB)
- Power Adult Tilt-in-Space Wheelchair Request (PDF, 92 KB)
- Power Wheelchair Validation Certificate (PDF, 156 KB)
- Wheelchair specification forms and parts
- Work order parts categories (PDF, 45 KB)