D1323 - Authority to Install/Modify - Home/Access Modifications
Form ID
D1323
Audience
For providers
Occupational therapist (general)
This form is used in conjunction with a request for Rehabilitation Appliances Program (RAP) home/access modifications.
If you are using an Apple computer and want to fill out your form electronically, please download the form and open it with Acrobat 7 or later.
How can I access this form?
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Form file format