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["SOCIAL DEVELOPMENT\nHealth Services Program\nP.O. Box 5500, Fredericton, N.B., E3B 5G4\nToll free number: 1-844-551-3015\nFax: (506) 453-3960",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"DÉVELOPPEMENT SOCIAL\nProgramme des services de santé\nC.P. 5500, Fredericton N.-B., E3B 5G4\nNuméro sans frais: 1-844-551-3015\nTélécopieur: (506) 453-3960",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"Couvert!$K$16","v":0}]
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[]
[]
[]
["PROGRAMME DE PRÊT D’ÉQUIPEMENT ADAPTÉ ET DE MOBILITÉ"]
["FORMULAIRE DE DEMANDE D'ÉQUIPEMENT ADAPTÉ COMPLEXE"]
[]
["RENSEIGNEMENTS SUR LE THERAPEUTE"]
["Date:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Nombre de pages"]
["Nom thérapeute",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Téléphone"]
["Courriel",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Télécopieur"]
["Agence / bureau",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Nom contact alternatif:"]
[]
["RENSEIGNEMENT SUR LE CLIENT"]
["Nom du client",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date de naissance"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"JJ",null,null,null,"MM",null,null,null,null,null,"AAAA"]
["No de la carte médicale",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,"Date d'expiration "]
["No carte d’assurance-maladie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"JJ",null,null,null,"MM",null,null,null,null,null,"AAAA"]
["Addresse complete",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Téléphone"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Language de choix"]
[]
["DÉTAILS DE LA DEMANDE"]
["État de la demande:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Raison d l’aiguillage "]
["\nDemande urgente:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Si oui, indiquez la raison:"]
["Type de demande d'équipement:",null,null,null,null,null,null,null,null,null,"Partie A-1 - Demande de prêt d'équipement"]
[null,null,null,null,null,null,null,null,null,null,"Partie A-2 - Demande pour le partage des coûts"]
[null,null,null,null,null,null,null,null,null,null,"Partie A-3  - Demande d’entretien d’équipment"]
[null,null,null,null,null,null,null,null,null,null,"Partie A-4 - Demande d’achat d’équipement d’essai"]
[null,null,null,null,null,null,null,null,null,null,"Partie A-5 - Demande de transfert d’équipement"]
[null,null,null,null,null,null,null,null,null,null,"Partie A-6 - Demande pour équipement à usagers multiples"]
[]
["DOCUMENTS SUPPLÉMENTAIRES INCLUS"]
[]
[null,null,null,"Partie D",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Estimation"]
[null,null,null,"Formulaire de commande du fabricant",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Dévis sur le formulaire de réclamation des services de santé"]
[null,null,null,"Preuve du PDSF",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Lettre d'autorisation du propriétaire pour des équipements installé en permanence."]
[null,null,null,"Lettre de prédétermination d'assurance privée"]
[null,null,null,"Autres",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Diagramme d'installation pour le lève-personne, y compris les"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"dimensions de la piece, des rails proposés et des appareils"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"permanents."]

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["SOCIAL DEVELOPMENT\nHealth Services Program\nP.O. Box 5500, Fredericton, N.B., E3B 5G4\nToll free number: 1-844-551-3015\nFax: (506) 453-3960",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"DÉVELOPPEMENT SOCIAL\nProgramme des services de santé\nC.P. 5500, Fredericton N.-B., E3B 5G4\nNuméro sans frais: 1-844-551-3015\nTélécopieur: (506) 453-3960",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"Couvert!$K$16","v":0}]
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[]
[]
[]
["Nom du client",null,null,null,null,null,null,{"$f":"Couvert!$K$16","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de la carte",null,null,null,null,null,null,null,{"$f":"Couvert!$P$18","v":""}]
[]
["PROGRAMME DE PRÊT D’ÉQUIPEMENT ADAPTÉ ET DE MOBILITÉ"]
["PARTIE A-1    DEMANDE DE PRÊT D'ÉQUIPEMENT"]
[]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie",null,null,null,null,null,null,null,null,null,null,null,"Veuillez sélectionner..."]
["Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Taille / Dimension"]
["No de critères d’admissibilité respectés **",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle préférées "]
[]
["Options/ Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés **"]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
["Options non négociables (pour les équipements recyclés):"]
[]
[]
["Renseignements supplémentaires / Spécifications"]
[]
[]
["Demande #2"]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie"]
["Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Taille / Dimension"]
["No de critères d’admissibilité respectés **",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle préférées "]
[]
["Options/ Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés **"]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
["Options non négociables (pour les équipements recyclés):"]
[]
[]
["Renseignements supplémentaires/ Spécifications"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["Demande #3"]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie"]
["Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Taille / Dimension"]
["No de critères d’admissibilité respectés **",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle préférées "]
[]
["Options/ Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés **"]
[]
[]
[]
[]
[]
[]
[]
[]
["Options non négociables (pour les équipements recyclés):"]
[]
[]
["Renseignements supplémentaires/ Spécifications"]
[]
[]
["Demande #4"]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie"]
["Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Taille / Dimension"]
["No de critères d’admissibilité respectés **",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle préférées "]
[]
["Options/ Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés **"]
[]
[]
[]
[]
[]
[]
[]
[]
["Options non négociables (pour les équipements recyclés):"]
[]
[]
["Renseignements supplémentaires/ Spécifications"]
[]
[]
["Demande #5"]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie"]
["Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Taille / Dimension"]
["No de critères d’admissibilité respectés **",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle préférées "]
[]
["Options/ Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés **"]
[]
[]
[]
[]
[]
[]
[]
[]
["Options non négociables (pour les équipements recyclés):"]
[]
[]
["Renseignements supplémentaires/ Spécifications"]
[]
[]
["Demande #6"]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie"]
["Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Taille / Dimension"]
["No de critères d’admissibilité respectés **",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle préférées "]
[]
["Options/ Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés **"]
[]
[]
[]
[]
[]
[]
[]
[]
["Options non négociables (pour les équipements recyclés):"]
[]
[]
["Renseignements supplémentaires/ Spécifications"]
[]
[]
["Demande #7"]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie"]
["Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Taille / Dimension"]
["No de critères d’admissibilité respectés **",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle préférées "]
[]
["Options/ Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés **"]
[]
[]
[]
[]
[]
[]
[]
[]
["Options non négociables (pour les équipements recyclés):"]
[]
[]
["Renseignements supplémentaires/ Spécifications"]
[]
[]
[]
[]
["** VEUILLEZ REMPLIR LA PARTIE D SI TOUS LES CRITÈRES D'ÉLIGIBILITÉ NE SONT PAS RESPECTÉS"]
["ÉQUIPEMENT QUI N'EST PLUS UTILISÉ"]
["Équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No inventaire TPNB",null,null,null,null,null,null,null,null,null,null,"Retournée à TPNB?",null,null,null,null,null,null,"Si non, veuillez indiquer la raison:"]
[]
[]
[]
[]
[]
[]
[]
[]
["INSTRUCTIONS D’EXPÉDITION "]
[]
[]
[]
[]
["SIGNATURE DU THÉRAPEUTE"]
[]
[null,null,null,null,"Je comprends que si aucun essai n’a été effectué et que si l’équipement fourni ne fonctionne pas pour le client, les Services de Santé pourraient considérer ne pas fournir de l’équipement supplémentaire pour adresser les mêmes besoins."]
[]
[]
[null,null,null,null,"Je confirme que l’évaluation est complétée et que ceci est la demande finale pour répondre aux besoins d’équipements adaptés de ce client."]
[]
[]
[]
[null,null,null,null,"Nom du thérapeute",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date"]

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["SOCIAL DEVELOPMENT\nHealth Services Program\nP.O. Box 5500, Fredericton, N.B., E3B 5G4\nToll free number: 1-844-551-3015\nFax: (506) 453-3960",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"DÉVELOPPEMENT SOCIAL\nProgramme des services de santé\nC.P. 5500, Fredericton N.-B., E3B 5G4\nNuméro sans frais: 1-844-551-3015\nTélécopieur: (506) 453-3960",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"Couvert!$K$16","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"Couvert!$P$18","v":""}]
[]
[]
[]
["Nom du client",null,null,null,null,null,null,{"$f":"Couvert!$K$16","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de la carte",null,null,null,null,null,null,null,{"$f":"Couvert!$P$18","v":""}]
[]
["PROGRAMME DE PRÊT D’ÉQUIPEMENT ADAPTÉ ET DE MOBILITÉ"]
["PARTIE A-2 DEMANDE POUR LE PARTAGE DES COÛTS"]
[]
["•","Veuillez vous référer aux procédures de partage des coûts de la politique des Services de Santé avant de compléter cette application."]
[]
[]
["•","Toutes les requêtes pour les enfants (600#) dont les familles détiennent une assurance privée doivent être soumises au travailleur social de cet enfant pour l’approbation financière avant que les Services de Santé soient en mesure de procéder avec la demande."]
[]
[]
["Partie I – A être complétée par le client"]
[]
["Je demande l’assistance des Services de Santé pour obtenir l’équipement indiqué dans cette demande.  J’ai attaché une copie de la lettre de prédétermination de l’autre compagnie d’assurance indiquant leur approbation et je fais la demande pour défrayer le reste des coûts."]
[]
[]
[]
["Équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Coût total"]
[]
["Autre compagnie d'assurance",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Montant préautorisé"]
[]
[]
["Je comprends que si les Services de Santé approuvent le partage des coûts de cet équipement, je vais appartenir cet équipement sauf si le montant demandé du programme dépasse le 50% des coûts de chaque pièce d’équipement. Dans ce cas, l’appartenance d’équipements recyclables sera transférée au programme de prêt d’équipement adapté et de mobilité."]
[]
[]
[]
[]
["Je consens aux conditions suivantes :"]
[]
[]
[null,"•","J'accepte à entretenir cet équipement comme instruit"]
[null,"•","J'accepte que toutes les réparations et entretien soient complétés par un fournisseur sous contrat avec le Développement Social"]
[null,"•","J'accepte d'utiliser cet équipement en toute sécurité"]
[null,"•","J'accepte de ne pas abuser ou mal utiliser cet équipement"]
[null,"•","J'accepte de retourner cet équipement à TPNB quand il ne sera plus nécessaire"]
[]
["Je suis conscient que les frais de réparations et de maintenance seront défrayés par le programme de Services de Santé aussi longtemps que ma carte de santé est active et que je détiens la couverture appropriée pour ces services."]
[]
[]
[]
[]
["Signature du client",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Témoin"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"OU"]
[]
[]
[]
["Gardien légal 1",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date"]
[]
[]
["1.","Si ce formulaire est signé par quelqu’un d’autre que le client, le signataire accepte la responsabilité de "]
[null,"respecter les termes de ce prêt d’équipement."]
[]
["SOCIAL DEVELOPMENT\nHealth Services Program\nP.O. Box 5500, Fredericton, N.B., E3B 5G4\nToll free number: 1-844-551-3015\nFax: (506) 453-3960",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"DÉVELOPPEMENT SOCIAL\nProgramme des services de santé\nC.P. 5500, Fredericton N.-B., E3B 5G4\nNuméro sans frais: 1-844-551-3015\nTélécopieur: (506) 453-3960"]
[]
[]
[]
[]
["Nom du client",null,null,null,null,null,null,{"$f":"Couvert!$K$16","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de la carte",null,null,null,null,null,null,null,{"$f":"Couvert!$P$18","v":""}]
[]
["Partie II – A être complété par un Ergothérapeute ou Physiothérapeute"]
[]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie",null,null,null,null,null,null,null,null,null,null,null,"Aides a la marche"]
["Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle"]
["No de critères d’admissibilité respectés **"]
[]
["Options/ Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés **"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Veuillez sélectionner..."]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
["Renseignements supplémentaires/ Spécifications "]
[]
[]
["Demande #2"]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie"]
["Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle"]
["No de critères d’admissibilité respectés **"]
[]
["Options/ Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés **"]
[]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
["Renseignements supplémentaires/ Spécifications "]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["Demande #3"]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie"]
["Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle"]
["No de critères d’admissibilité respectés **"]
[]
["Options/ Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés **"]
[]
[]
[]
[]
[]
[]
[]
[]
["Renseignements supplémentaires/ Spécifications "]
[]
[]
["Request #4"]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie"]
["Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle"]
["No de critères d’admissibilité respectés **"]
[]
["Options/ Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés **"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Please select..."]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
["Renseignements supplémentaires/ Spécifications "]
[]
[]
[]
["** VEUILLEZ COMPLÉTER LA PARTIE « D » SI TOUS LES CRITÈRES D’ÉLIGIBILITÉ NE SONT PAS RESPECTÉS."]
["ÉQUIPEMENT QUI N'EST PLUS UTILISÉ"]
["Équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No inventaire TPNB",null,null,null,null,null,null,null,null,null,null,"Retournée à TPNB?",null,null,null,null,null,null,"Si non, veuillez indiquer la raison:"]
[]
[]
[]
[]
[]
[]
[]
[]
["SIGNATURE DU THÉRAPEUTE"]
[]
[null,null,null,null,"Je comprends que si l’essai n’est pas complété et que si l’équipement fourni ne fonctionne pas pour le client, les Services de Santé pourraient ne pas considérer fournir de l’équipement supplémentaire pour adresser les mêmes besoins."]
[]
[]
[null,null,null,null,"Je confirme que l’évaluation est complétée et que ceci est la demande finale pour remplir les besoins adaptés de ce client."]
[]
[]
[]
[null,null,null,null,"Nom du thérapeute",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date"]

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["SOCIAL DEVELOPMENT\nHealth Services Program\nP.O. Box 5500, Fredericton, N.B., E3B 5G4\nToll free number: 1-844-551-3015\nFax: (506) 453-3960",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"DÉVELOPPEMENT SOCIAL\nProgramme des services de santé\nC.P. 5500, Fredericton N.-B., E3B 5G4\nNuméro sans frais: 1-844-551-3015\nTélécopieur: (506) 453-3960",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"Couvert!$K$16","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"Couvert!$P$18","v":""}]
[]
[]
[]
["Nom du client",null,null,null,null,null,null,{"$f":"Couvert!$K$16","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de la carte",null,null,null,null,null,null,null,{"$f":"Couvert!$P$18","v":""}]
[]
["PROGRAMME DE PRÊT D’ÉQUIPEMENT ADAPTÉ ET DE MOBILITÉ"]
["PARTIE A-3   DEMANDE D’ENTRETIEN D’ÉQUIPEMENT"]
[]
["*** Veuillez consulter la politique et les procédures d’entretien de l'équipement avant de remplir ce formulaire.***"]
[]
[]
["Partie I – A compléter par le client"]
[]
["Je fais l’application pour la couverture de réparations courantes ou futures, des réparations ou la fourniture de composantes additionnelles pour de l’équipement qui ne m’a pas été fourni à travers le programme des Services de Santé et qui est listé dans la partie II du formulaire."]
[]
[]
["Je comprends que tout l’équipement détaillé dans la partie II de cette application peut ne pas être approuvée pour de la maintenance et que mon thérapeute va recevoir un courriel détaillant l’équipement et/ou les composantes qui ont été approuvées pour cette couverture.  Avec cette approbation. Je comprends que les réparations, la maintenance et/ou la fourniture d’équipements ou de composantes additionnelles seront éligibles pour approbation aussi longtemps que je détienne une carte de santé active incluant la couverture appropriée et que je consente aux termes et conditions suivantes :"]
[]
[]
[]
[]
[]
[null,null,"1.",null,"Je confirme que cet équipement m'appartient"]
[null,null,"2.",null,"Je confirme de ne pas avoir d’autre équipement remplissant le même besoin."]
[null,null,"3.",null,"Je confirme ma responsabilité de prendre soin de cet équipement comme instruit par mon thérapeute et/ou fournisseur autorisé."]
[]
[null,null,"4.",null,"Je confirme que toutes les réparations, l'entretien et des autres équipement connexes seront effectuées par un fournisseur autorisé qui est couramment sous contrat avec le Dévelopement Social."]
[]
[null,null,"5.",null,"Je confirme que je vais utiliser cet équipement en toute sécurité"]
[null,null,"6.",null,"Je confirme que cet équipement ne ser en aucun cas abusé ou mal utilisé"]
[null,null,"7.",null,"Je comprends que cette entente sera terminée lorsque l’équipement sera remplacé ou n'est plus nécessaire."]
[]
[]
[]
["Signature du client",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Témoin"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"OU"]
[]
[]
[]
["Gardien légale 1",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date"]
[]
[]
["1.","Si ce formulaire est signé par quelqu’un d’autre que le client, le signataire accepte la responsabilité de respecter les termes de ce prêt d’équipement"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["SOCIAL DEVELOPMENT\nHealth Services Program\nP.O. Box 5500, Fredericton, N.B., E3B 5G4\nToll free number: 1-844-551-3015\nFax: (506) 453-3960",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"DÉVELOPPEMENT SOCIAL\nProgramme des services de santé\nC.P. 5500, Fredericton N.-B., E3B 5G4\nNuméro sans frais: 1-844-551-3015\nTélécopieur: (506) 453-3960"]
[]
[]
[]
[]
["Nom du client",null,null,null,null,null,null,{"$f":"Couvert!$K$16","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de la carte",null,null,null,null,null,null,null,{"$f":"Couvert!$P$18","v":""}]
[]
["Partie II – A être complété par un Ergothérapeute ou Physiothérapeute"]
[]
["1.",null,"Veuillez compléter cette section pour les équipements et/ou les pièces qui ne furent pas fournis par le programme des Services de Santé et que le client voudrait maintenir."]
[]
[]
["2.",null,"Toutes les options et composantes en relation avec les équipements à faire maintenir doivent être énumérées sur cette application, même si elles n’ont pas besoin de réparations au moment de l’application.  Si ces options ou ces composantes ont des critères éligibles aux services de Santé, ces critères doivent être énumérées lors de l’application."]
[]
[]
[]
["•",null,"Veuillez-vous référer au guide (PPEAM) pour les bénéfices éligibles et les critères associées."]
[]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie"]
["Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle"]
["Numéro de série:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères d’admissibilité respectés **"]
[]
["Age de l'équipement:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Nom de l'acheteur de l'équipement:"]
[]
["Options/ Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés **"]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
["Renseignements supplémentaires/ Spécifications "]
[]
[]
[]
["Demande #2"]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie"]
["Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle"]
["Numéro de série:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères d’admissibilité respectés **"]
[]
["Age de l'équipement:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Nom de l'acheteur de l'équipement:"]
[]
["Options/ Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés **"]
[]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
["Renseignements supplémentaires/ Spécifications "]
[]
[]
[]
[]
[]
[]
[]
["Demande #3"]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie"]
["Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle"]
["Numéro de série:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères d’admissibilité respectés **"]
[]
["Age de l'équipement:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Nom de l'acheteur de l'équipement:"]
[]
["Options/ Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés **"]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
["Renseignements supplémentaires/ Spécifications "]
[]
[]
[]
["Demande #4"]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie"]
["Prestation",null,null,null,null,null,"Select after category...",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle"]
["Numéro de série:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères d’admissibilité respectés **"]
[]
["Age de l'équipement:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Nom de l'acheteur de l'équipement:"]
[]
["Options/ Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés **"]
[]
[]
[]
[]
[]
[]
[]
[]
["Renseignements supplémentaires/ Spécifications "]
[]
[]
[]
["** VEUILLEZ COMPLÉTER LA PARTIE « D » SI TOUS LES CRITÈRES D’ÉLIGIBILITÉ NE SONT PAS RESPECTÉS."]
[]
["SIGNATURE DU THÉRAPEUTE"]
[]
[null,null,null,"Je confirme que les équipements énumères ci-haut rencontrent les besoins médicaux courants du client et que cet équipement est présentement en bon état ou avec besoin de réparations mineures."]
[]
[]
[null,null,null,"Je confirme que l’évaluation de ce client est complète et que ceci est la dernière demande pour remplir les besoins d’équipements adaptés de ce client."]
[]
[]
[]
[]
[null,null,null,"Nom du thérapeute",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date"]

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["SOCIAL DEVELOPMENT\nHealth Services Program\nP.O. Box 5500, Fredericton, N.B., E3B 5G4\nToll free number: 1-844-551-3015\nFax: (506) 453-3960",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"DÉVELOPPEMENT SOCIAL\nProgramme des services de santé\nC.P. 5500, Fredericton N.-B., E3B 5G4\nNuméro sans frais: 1-844-551-3015\nTélécopieur: (506) 453-3960",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"Couvert!$K$16","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"Couvert!$P$18","v":""}]
[]
[]
[]
["Nom du client",null,null,null,null,null,null,{"$f":"Couvert!$K$16","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de la carte",null,null,null,null,null,null,null,{"$f":"Couvert!$P$18","v":""}]
[]
["PROGRAMME DE PRÊT D’ÉQUIPEMENT ADAPTÉ ET DE MOBILITÉ"]
["PARTIE A-4  DEMANDE D’ACHAT D’ÉQUIPEMENT D’ESSAI."]
[]
["Équipement (Marque et modèle)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Numéro de série",null,null,null,null,null,null,null,null,null,"Date de fabrication",null,null,null,null,null,null,null,null,null,"Équipement neuf ou démonstration"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["SIGNATURE DU THERAPEUTE"]
[]
[null,null,null,"Je confirme avoir lu et compris les politiques et procédures en relation avec l’achat d’équipement d’essai, comme élaboré dans Les politiques et procédures d’achat d’équipement d’essai."]
[]
[]
[]
[null,null,null,"Je comprends que l’achat d’équipement d’essai sera seulement considéré lorsque les Services de Santé auront confirmé que Timbres de Pâques NB ne détiennent pas l’équipement nécessaire disponible."]
[]
[]
[null,null,null,"J’ai déterminé que l’équipement d’essai mentionné ci-haut rempli les besoins de ce client exactement comme il est et je recommande qu’il soit acheté pour le programme de prêt d’équipement adapté et de mobilité et prêté à ce client."]
[]
[]
[]
[]
[]
[null,"Nom du thérapeute",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date"]

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["SOCIAL DEVELOPMENT\nHealth Services Program\nP.O. Box 5500, Fredericton, N.B., E3B 5G4\nToll free number: 1-844-551-3015\nFax: (506) 453-3960",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"DÉVELOPPEMENT SOCIAL\nProgramme des services de santé\nC.P. 5500, Fredericton N.-B., E3B 5G4\nNuméro sans frais: 1-844-551-3015\nTélécopieur: (506) 453-3960",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"Couvert!$K$16","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"Couvert!$P$18","v":""}]
[]
[]
[]
["Nom du client",null,null,null,null,null,null,{"$f":"Couvert!$K$16","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de la carte",null,null,null,null,null,null,null,{"$f":"Couvert!$P$18","v":""}]
[]
["PROGRAMME DE PRÊT D’ÉQUIPEMENT ADAPTÉ ET DE MOBILITÉ"]
["PARTIE A-5   DEMANDE DE TRANSFERT D’ÉQUIPEMENT"]
[]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie"]
["Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle"]
["No de série",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères d’admissibilité respectés **"]
[]
["Initiales de l'utilisateur précédent:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de carte de l'utilisateur précédent:"]
[]
["No inventaire TPNB",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"L'équipement a-t-il été nettoyé et désinfecté?"]
[]
["Options** / Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés **"]
[]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
["Renseignements supplémentaires/ Spécifications "]
[]
[]
["Demande #2"]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie"]
["Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle"]
["No de série",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères d’admissibilité respectés **"]
[]
["Initiales de l'utilisateur précédent:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de carte de l'utilisateur précédent:"]
[]
["No inventaire TPNB",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"L'équipement a-t-il été nettoyé et désinfecté?"]
[]
["Options** / Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés **"]
["ADL Positioning Additional Services",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Please select..."]
[]
[]
[]
[]
[]
[]
[]
["Renseignements supplémentaires/ Spécifications "]
[]
[]
[]
[]
[]
[]
[]
[]
["Demande #3"]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie"]
["Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle"]
["No de série",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères d’admissibilité respectés **"]
[]
["Initiales de l'utilisateur précédent:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de carte de l'utilisateur précédent:"]
[]
["No inventaire TPNB",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"L'équipement a-t-il été nettoyé et désinfecté?"]
[]
["Options** / Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés **"]
[]
[]
[]
[]
[]
[]
[]
[]
["Renseignements supplémentaires/ Spécifications "]
[]
[]
[]
["Demande #4"]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie",null,null,null,null,null,null,null,null,null,null,null,"Please select..."]
["Prestation",null,null,null,null,null,"Select after category...",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle"]
["No de série",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères d’admissibilité respectés **"]
[]
["Initiales de l'utilisateur précédent:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de carte de l'utilisateur précédent:"]
[]
["No inventaire TPNB",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"L'équipement a-t-il été nettoyé et désinfecté?"]
[]
["Options** / Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés **"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
["Renseignements supplémentaires/ Spécifications "]
[]
[]
[]
["** VEUILLEZ COMPLÉTER LA PARTIE « D » SI TOUS LES CRITÈRES D’ÉLIGIBILITÉ NE SONT PAS RESPECTÉS."]
[]
["SIGNATURE DU THÉRAPEUTE"]
[]
[null,null,null,"Je confirme que l’équipement d’essai a été mis à l’essai avec le client et qu’il rencontre ses besoins médicaux courants."]
[]
[]
[null,null,null,"Je confirme que l’évaluation de ce client est complète et que ceci est la demande finale d’équipement qui rencontre les besoins d'équipement adapté de ce client."]
[]
[]
[]
[]
[null,null,null,"Nom du thérapeute",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date"]

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["SOCIAL DEVELOPMENT\nHealth Services Program\nP.O. Box 5500, Fredericton, N.B., E3B 5G4\nToll free number: 1-844-551-3015\nFax: (506) 453-3960",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"DÉVELOPPEMENT SOCIAL\nProgramme des services de santé\nC.P. 5500, Fredericton N.-B., E3B 5G4\nNuméro sans frais: 1-844-551-3015\nTélécopieur: (506) 453-3960",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"Couvert!$K$16","v":0}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"Couvert!$P$18","v":""}]
[]
[]
[]
["Nom du client",null,null,null,null,null,null,{"$f":"Couvert!$K$16","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de la carte",null,null,null,null,null,null,null,{"$f":"Couvert!$P$18","v":""}]
[]
["PROGRAMME DE PRÊT D’ÉQUIPEMENT ADAPTÉ ET DE MOBILITÉ"]
["PARTIE A-6  DEMANDE D’ÉQUIPEMENT À USAGERS MULTIPLES"]
[]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie:"]
["Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Taille / Dimensions"]
["No de critères d’admissibilité respectés **",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle préférés:"]
[]
["Le client nommé sur la page de couverture de cette demande est:"]
["Options/ Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés**"]
[]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
["Options non négociables (pour les équipements recyclés):"]
[]
[]
["Informations additionnelles/ Spécifications"]
[]
[]
[]
["Demande #2"]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie:",null,null,null,null,null,null,null,null,null,null,null,"Please select..."]
["Prestation",null,null,null,null,null,"Select after category...",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Taille / Dimensions"]
["No de critères d’admissibilité respectés **",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle préférés:"]
[]
["Le client nommé sur la page de couverture de cette demande est:"]
["Options/ Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés**"]
[]
[]
[]
[]
[]
[]
[]
[]
["Options non négociables (pour les équipements recyclés):"]
[]
[]
["Additional information / Specifications"]
[]
[]
[]
[]
[]
[]
[]
["Demande #3"]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie:"]
["Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Taille / Dimensions"]
["No de critères d’admissibilité respectés **",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle préférés:"]
[]
["Le client nommé sur la page de couverture de cette demande est:"]
["Options/ Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés**"]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[" ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
["Options non négociables (pour les équipements recyclés):"]
[]
[]
["Additional information / Specifications"]
[]
[]
[]
["Demande #4"]
["Type d'équipement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Catégorie:"]
["Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Taille / Dimensions"]
["No de critères d’admissibilité respectés **",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Marque et modèle préférés:"]
[]
["Le client nommé sur la page de couverture de cette demande est:"]
["Options/ Services supplémentaires"]
["Catégorie",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Prestation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de critères respectés**"]
[]
[]
[]
[]
[]
[]
[]
[]
["Options non négociables (pour les équipements recyclés):"]
[]
[]
["Additional information / Specifications"]
[]
[]
[]
["** VEUILLEZ COMPLÉTER LA PARTIE « D » SI TOUS LES CRITÈRES D’ÉLIGIBILITÉ NE SONT PAS RESPECTÉS."]
[]
["THERAPIST'S SIGNATURE"]
[]
[null,null,null,"Je comprends que si la période d’essai n’est pas complétée et que l’équipement ne fonctionne pas pour le client, les Services de Santé pourraient ne pas considérer fournir de l’équipement supplémentaire pour remplir le même besoin."]
[]
[]
[null,null,null,"Je confirme que l’évaluation de ce client est complète et que ceci est la demande finale d’équipement pour remplir les besoins adapté du client."]
[]
[]
[]
[null,null,null,"Nom du thérapeute",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date"]

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["SOCIAL DEVELOPMENT\nHealth Services Program\nP.O. Box 5500, Fredericton, N.B., E3B 5G4\nToll free number: 1-844-551-3015\nFax: (506) 453-3960",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"DÉVELOPPEMENT SOCIAL\nProgramme des services de santé\nC.P. 5500, Fredericton N.-B., E3B 5G4\nNuméro sans frais: 1-844-551-3015\nTélécopieur: (506) 453-3960",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"Couvert!$K$16","v":0}]
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[]
[]
[]
["Nom du client",null,null,null,null,null,null,{"$f":"Couvert!$H$16","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de la carte:",null,null,null,null,null,null,null,{"$f":"Couvert!$H$18","v":0}]
[]
["PARTIE B - CONSENTEMENT À LA PUBLICATION DE RENSEIGNEMENTS"]
[]
["Je, __________________________________________________________, consens au partage de mon information de santé personnelle parmi les partis suivants :  Incluant mais aucunement limité au Développement Social, Timbres de Pâques NB, mon Ergothérapeute, mon Physiothérapeute et le fournisseur d’équipements choisi."]
[]
[]
[]
["Cette autorisation permet aux divers partis de communiquer par téléphone, courriel, télécopieur memo, texte et lettre dans le but d’obtenir les équipements prescrits."]
[]
[]
[]
["Signature du client",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Témoin"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"OU"]
[]
[]
["Guardien légale 2",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date"]
[]
[]
["PARTIE C - ENTENTE DE PRET D'ÉQUIPEMENT"]
[]
["Je comprends et suis en accord avec les termes et conditions suivantes :"]
[]
[null,"1.",null,"L’équipement me sera prêté aussi longtemps que j’en aurai le besoin.  Lorsqu’il sera remplacé ou plus nécessaire, je contacterai les Timbres de Pâques NB au 1-888-280-8155 pour déterminer s’il doit être retourné au programme. 1"]
[]
[null,"2.",null,"L’équipement doit être entretenu selon les directives de mon thérapeute ou de mon fournisseur."]
[null,"3.",null,"Les réparation et l'entretien sera fourni gratuitement par les Services de Santé, aussi longtemps que je détiens une carte d'assistance médicale active avec la couverture appropriée et que je respecte les termes de cette entente."]
[]
[null,"4.",null,"Toutes réparations et l'entretien doit être effectuée par un fournisseur autorisé."]
[null,"5.",null,"Cet équipement doit être opéré sécuritairement en tout temps."]
[null,"6.",null,"Cet équipement ne doit aucunement être abusé ou maltraité."]
[]
[]
[]
[null,"Signature du client",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Témoin"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"OU"]
[]
[]
[null,"Gardien légale 2",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date"]
[]
[]
["1. Tous les frais associés avec le retour de l’équipement à Timbres de Pâques NB seront défrayés par le programme des Services de Santé. "]
[]
["2. Si ce formulaire est signé par quelqu’un d’autre que le client, le signataire accepte la responsabilité de respecter les termes de ce prêt d’équipement."]

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["SOCIAL DEVELOPMENT\nHealth Services Program\nP.O. Box 5500, Fredericton, N.B., E3B 5G4\nToll free number: 1-844-551-3015\nFax: (506) 453-3960",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"DÉVELOPPEMENT SOCIAL\nProgramme des services de santé\nC.P. 5500, Fredericton N.-B., E3B 5G4\nNuméro sans frais: 1-844-551-3015\nTélécopieur: (506) 453-3960",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"Couvert!$K$16","v":0}]
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[]
[]
[]
["Nom du client",null,null,null,null,null,null,{"$f":"Couvert!$H$16","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No de la carte",null,null,null,null,null,null,null,{"$f":"Couvert!$H$18","v":0}]
[]
["PARTIE D – RENSEIGNEMENTS SUPPLÉMENTAIRES"]
[]
["Veuillez utiliser cet espace pour fournir les informations nécessaires :"]
[]
["•",null,"Veuillez-vous référer à la section “ Comment remplir la partie D de la demande d’équipement » dans le guide du programme de prêt d’équipement adapté et de mobilité pour des exemples spécifiques sur quelle information est requise."]
[]
[]
[]
["•",null,"Remarque: Lorsque vous remplissez la partie D, n'oubliez pas d'utiliser «alt-enter» pour passer de la fin d'une ligne au début de la suivante"]

{"sheet":"VL123","index":9,"n_rows":20,"n_cols":2,"rows_kept":20,"cut":false,"hidden":true,"merged":[]}
["123DD"]
["Aides à la marche complexe","ComplexAmbulationAids"]
["Aides salle de bain complexe","ComplexBathroomAids"]
["Aides stabilité complexe","ComplexStabilityAids"]
["Aides transfer complexe","ComplexTransferAids"]
["Aides thérapeutiques au sommeil","TherapeuticSleepAids"]
["Positionnement AVQ ","ADLPositioning"]
[]
["123VList"]
["Aides à la marche","AmbulationAids"]
["Aides au bain","BathingAids"]
["Aides à la toilette","ToiletingAids"]
["Aides à la verticalisation ","StandingAids"]
["Aides au transfert complexes","TransferAids"]
["Lève-personnes","PatientLifts"]
["Lits d’hôpitaux","HospitalSleepBeds"]
["Surfaces d’appui réactives","ReactiveSupport"]
["Surfaces d’appui actives","ActiveSupport"]
["Surface de répartition de la pression","PressureRedistributing"]
["Positionnement pour les AVQ ","PositioningforADL"]

{"sheet":"Sheet1","index":10,"n_rows":18,"n_cols":2,"rows_kept":18,"cut":false,"hidden":true,"merged":[]}
["Complex Ambulation Aids","ComplexAbulationAidsB"]
["Complex Bathroom Aids","ComplexBathroomAidsB"]
["Complex Stability Aids","ComplexStabilityAidsB"]
["Complex Transfer Aids","ComplexTransferAidsB"]
["Therapeutic Sleep Aids","TherapeuticSleepAidsB"]
["ADL Positioning","ADLPositioningB"]
[]
["Complex Ambulation Aids Options","ComplexAmbulationAidsOptions"]
["Complex Ambulation Aids Additional Services","ComplexAmbulationAidsAdditionalServices"]
["Complex Bathroom Aids Options","ComplexBathroomAidsOptions"]
["Complex Bathroom Aids Additional Services","ComplexBathroomAidsAdditionalServices"]
["Stability Aids Options","StabilityAidsOptions"]
["Stability Aids Additional Services","StabilityAidsAdditionalServices"]
["Transfer Aids Options","TransferAidsOptions"]
["Transfer Aid Additional Services","TransferAidsAdditionalServices"]
["Therapeutic Sleep Aid Options","TherapeuticSleepAidsOptions"]
["Therapeutic Sleep Aid Additional Services","TherapeuticSleepAidsAdditionalServices"]
["ADL Positioning Additional Services","ADLPos"]

{"sheet":"L123","index":11,"n_rows":20,"n_cols":14,"rows_kept":20,"cut":false,"hidden":true,"merged":[]}
["List1A",null,null,"ComplexAmbulationAids",null,"ComplexBathroomAids",null,"ComplexStabilityAids",null,"ComplexTransferAids",null,"TherapeuticSleepAids",null,"ADLPositioning"]
["Aides à la marche complexe","ComplexAmbulationAids",null,"Aides à la marche",null,"Aides au bain",null,"Aides à la verticalisation ",null,"Aides au transfert complexes",null,"Lits d’hôpitaux",null,"Surface de répartition de la pression"]
["Aides salle de bain complexe","ComplexBathroomAids",null,null,null,"Aides à la toilette",null,null,null,"Lève-personnes",null,"Surfaces d’appui réactives",null,"Positionnement pour les AVQ "]
["Aides stabilité complexe","ComplexStabilityAids",null,null,null,null,null,null,null,null,null,"Surfaces d’appui actives"]
["Aides transfer complexe","ComplexTransferAids"]
["Aides thérapeutiques au sommeil","TherapeuticSleepAids",null,"AmbulationAids",null,"BathingAids",null,"StandingAids",null,"TransferAids",null,"HospitalSleepBeds",null,"PressureRedistributing"]
["Positionnement AVQ ","ADLPositioning",null,"Appareil de rééducation à la marche",null,"Siège de bain complexe",null,"Cadre de verticalisation ",null,"Barre de trapèze autoportante au dessus du lit ",null,"Lit d’hôpital standard",null,"Surface pour la toilette/le bain"]
[null,null,null,"Déambulateur spécialisé",null,"Siège élévateur de bain ",null,null,null,"Aide transfert verticale non motorisée ",null,"Lit d’hôpital bariatrique",null,"Coussin extérieur de fauteuil roulant"]
["Aides à la marche","AmbulationAids",null,"Déambulateur à plateforme",null,null,null,null,null,null,null,"Lit d’hôpital non standard"]
["Aides au bain","BathingAids",null,null,null,"ToiletingAids",null,null,null,"PatientLifts",null,"Lit spécialisé",null,"PositioningforADL"]
["Aides à la toilette","ToiletingAids",null,null,null,"Bidet monté sur la toilette",null,null,null,"Lève-personne électrique/hydraulique",null,"Lit spécialisé (fermé)",null,"Chaises spécialisées et inserts"]
["Aides à la verticalisation ","StandingAids",null,null,null,"Support complexe monté sur la toilette",null,null,null,"Lève-personne suspendu portatif"]
["Aides au transfert complexes","TransferAids",null,null,null,"Chaise d’aisance complexe",null,null,null,"Rail installé au plafond ",null,"ReactiveSupport"]
["Lève-personnes","PatientLifts",null,null,null,"Chaise de douche complexe",null,null,null,"Toiles",null,"Matelas en mousse à haute densité"]
["Lits d’hôpitaux","HospitalSleepBeds",null,null,null,"Chaise d'aisance basculant",null,null,null,null,null,"Systèmes de surmatelas"]
["Surfaces d’appui réactives","ReactiveSupport",null,null,null,null,null,null,null,null,null,"Surface d’appui non motorisée"]
["Surfaces d’appui actives","ActiveSupport"]
["Surface de répartition de la pression","PressureRedistributing",null,null,null,null,null,null,null,null,null,"ActiveSupport"]
["Positionnement pour les AVQ ","PositioningforADL",null,null,null,null,null,null,null,null,null,"Surface d’appui active motorisée"]
[null,null,null,null,null,null,null,null,null,null,null,"Surface multizone"]

{"sheet":"L145","index":12,"n_rows":20,"n_cols":14,"rows_kept":20,"cut":false,"hidden":true,"merged":[]}
["CAList1-B",null,null,"ComplexAbulationAidsB",null,"ComplexBathroomAidsB",null,"ComplexStabilityAidsB",null,"ComplexTransferAidsB",null,"TherapeuticSleepAidsB",null,"ADLPositioningB"]
["Aides à la marche complexe","ComplexAbulationAidsB",null,"Options d’aide à la marche ",null,"Options d'aides pour la salle de bains ",null,"Options d’aide à la verticalisation",null,"Options de lève-personnes",null,"Options d'aides thérapeutiques au sommeil",null,"Services supplémentaires-aides  AVQ"]
["Aides salle de bain complexe","ComplexBathroomAidsB",null,"Services additionnels - aides à la marche ",null,"Services additionnels - aides pour salle de bain ",null,"Services supplémentaires-aides à verticalisation ",null,"Services supplémentaire - Aides au transfert",null,"Options des aides thérapeutiques au sommeil"]
["Aides stabilité complexe","ComplexStabilityAidsB"]
["Aides transfer complexe","ComplexTransferAidsB"]
["Aides thérapeutiques au sommeil","TherapeuticSleepAidsB"]
["Positionnement AVQ ","ADLPositioningB",null,"ComplexAmbulationAidsOptions",null,"ComplexBathroomAidsOptions",null,"StabilityAidsOptions",null,"TransferAidsOptions",null,"TherapeuticSleepAidsOptions",null,"ADLPos"]
[null,null,null,"Barre de navigation pour l'accompagnateur",null,"cadre de mobilité",null,"Appui-tête",null,"Rails supplémentaires",null,"Ridelles de lit supplémentaires",null,"Modifications"]
["Options d’aide à la marche ","ComplexAmbulationAidsOptions",null,"Appui-tête",null,"Surface de redistribution de la pression",null,"Positionnement des membres inférieurs",null,"Longeur supériere à 3 m",null,"Housses coussinées pour ridelles",null,"Locations"]
["Services additionnels - aides à la marche ","ComplexAmbulationAidsAdditionalServices",null,"Support des membres inférieurs",null,"Options pour positionement supplémentaires",null,"Support du tronc ",null,"Sangles d'extension portatives",null,"Aides d'agranissement du lit"]
["Options d'aides pour la salle de bains ","ComplexBathroomAidsOptions",null,"Base non standard",null,null,null,"Support des membres supérieurs",null,null,null,"Coussin (bolster)"]
["Services additionnels - aides pour la salle de bain ","ComplexBathroomAidsAdditionalServices",null,"Châssis supérieur non standard",null,"ComplexBathroomAidsAdditionalServices",null,null,null,"TransferAidsAdditionalServices",null,"Protège-matelas plus grand"]
["Options d’aide à la verticalisation","StabilityAidsOptions",null,"Options de roues non standard",null,"Modifications",null,"StabilityAidsAdditionalServices",null,"Modifications",null,"Sectons thérapeutiques modulaires"]
["Services supplémentaires-aides à verticalisation ","StabilityAidsAdditionalServices",null,"Siège, toile",null,"Locations",null,"Modifications",null,"Locations",null,"Positionnement du surmatelas "]
["Options de lève-personnes","TransferAidsOptions",null,"Soutien du tronc ",null,null,null,"Locations",null,null,null,"Deuxième protège-matelas"]
["Services supplémentaire - Aides au transfert","TransferAidsAdditionalServices",null,"Support des membres supérieurs",null,null,null,null,null,null,null,"Position de Trendelenburg"]
["Options d'aides thérapeutiques au sommeil","TherapeuticSleepAidsOptions"]
["Options des aides thérapeutiques au sommeil","TherapeuticSleepAidsAdditionalServices",null,"ComplexAmbulationAidsAdditionalServices",null,null,null,null,null,null,null,"TherapeuticSleepAidsAdditionalServices"]
["Services supplémentaires-aides  AVQ","ADLPos",null,"Modifications",null,null,null,null,null,null,null,"Modifications"]
[null,null,null,"Locations",null,null,null,null,null,null,null,"Locations"]