Medicare Power Scooter Examination

Patient Information

• Name: Arthur Pendelton
• Date of Birth: 14/05/1948
• Medicare Number: 4G82-WK9-3318

Clinical Information

• Diagnosis: Severe bilateral knee osteoarthritis (M17.0)
• Secondary Diagnoses: COPD (GOLD stage III), bilateral rotator cuff tendinopathy, HTN
• Duration of Condition: 6 years, with progressive decline over the past 8 months
• Prognosis: Poor for functional recovery; progressive degenerative course

Functional Limitations

• Mobility: Unable to ambulate > 15 feet with a rollator due to severe bilateral knee pain and exertional dyspnoea (SpO2 drops to 89 % on room air). High fall risk; 2 falls in the past 6 months.
• Activities of Daily Living: Unable to stand or ambulate sufficiently to complete MRADLs including meal preparation, toileting transfers, and hygiene tasks within the home.
• Other Limitations: Bilateral upper extremity weakness (3+/5 shoulder abduction) and pain preclude self-propulsion of a manual wheelchair.

Medical Necessity

• Justification for Power Scooter: Patient cannot safely ambulate within the home to perform MRADLs. A cane or walker is insufficient due to severe pain and COPD-related dyspnoea. A manual wheelchair is contraindicated due to bilateral rotator cuff pathology and reduced cardiopulmonary reserve. Patient maintains adequate trunk stability, vision, and cognition to safely operate a POV/power scooter.
• Previous Interventions: Intra-articular corticosteroid injections (minimal relief), physical therapy (failed to improve ambulation distance), meloxicam 15 mg PO OD, salbutamol (albuterol, ProAir®) 90 mcg INH Q4H PRN, and rollator walker trial (inadequate support).
• Expected Improvement: Independent, safe mobility within the home to perform MRADLs, decreased fall risk, and reduced cardiopulmonary strain.

Additional Information

• Home Environment: Single-story residence with ramp access at the front entrance. Doorways measure 36 inches wide; hallway turning radius and room layouts accommodate a standard 3-wheel power scooter.
• Caregiver Support: Lives with spouse (aged 74) who has lumbar spinal stenosis and is physically unable to push a manual wheelchair.
• Other Relevant Information: Patient demonstrated safe transfer to/from seating and sufficient cognitive/visual acuity to operate tiller steering controls during office evaluation.

Clinician Information

• Clinician's Name: Dr. Sarah Jenkins
• Clinician's Title: MD, Family Medicine Specialist
• Clinician's Contact Information: Prairie View Family Medicine, 412 N Michigan Ave, Suite 300, Chicago, IL 60611 | Tel: (312) 555-0194 | NPI: 1841293847
• Date of Report: 24/10/2023