Order Form RAP Mobility & Functional Support Products (D0992)
This form is used to request mobility aids and functional support equipment through the Rehabilitation Appliances Program for eligible veterans and their dependants.
When do you need this form?
A veteran or their dependant needs mobility aids, appliances, or functional support equipment due to a service-related disability or medical condition. The equipment must be prescribed by an eligible healthcare provider such as an occupational therapist, registered nurse, physiotherapist, or doctor.
What you'll need
- DVA file number and card type (Gold or White card)
- Healthcare provider details and professional registration numbers
- Specific equipment details including RAP item numbers and specifications
- Client's delivery address and contact information
- Clinical justification for prior approval items or White Card holders
Where to send it
The completed form should be submitted through the healthcare provider to DVA via the RAP provider hotline 1800 550 457 (Option 1) or as directed by the prescribing healthcare professional.
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This is the original D0992 form from Department of Veterans' Affairs (DVA), unmodified. Learn more about how we work →