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Calculating the total Disability Care Load Assessment Determination (DCLAD) (2020) score 009-05030010

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THP Medical Report validation triggers

Table 1: This table describes validation question triggers using THP Medical Report.

Subject Area

ACL Care Needs Assessment

THP Medical Report

Assistance with breathing

Q.40 a, b, c, d

M-10b

Self harm behaviour

Q.18 b, c, or d

M-9b

Absconding

Q.11 d

M-9d

Aggression

Q.13 d

M-9c

Incontinent day and night

Q.30 c or d

(if child over 4 years)

M-10c

Specialised communication equipment

Q.5c

M-10i

Poorly controlled seizures

Q.49

M-10m

Anorexia

Q.51

M-10o

Chemotherapy or radiotherapy

Q.52

M-10l

Blood tests

Q.54h

M-10n

ACL Care Needs Assessment

Table 2: This table describes validation question triggers using ACL Care Needs Assessment.

Subject Area

ACL Care Needs Assessment

ACL Care Needs Assessment

Emotional Extremes

Q.14d

Q.15d

Multiple medical reports

Table 3: This table describes scenarios of which medical report to use when the carer lodges more than 1 medical report for the same CP and/or CA claim.

Example

Description

Example 1

Carer claims CA and lodges claim and medical report. Claim is processed 3 months later. CA rejected due to non-qualifying DCLAD. Carer qualifies for CA HCC only.

Carer appeals decision within 13 weeks and provides a new THP professional questionnaire, with a qualifying LoRD condition.

In this example CA can be granted from the date of claim using the latest medical report if the recognised disability existed at the time the claim was lodged.

Example 2

Carer claims CA for 2 children who are twins. Both children have the same conditions. The THP has ticked a box in the Haematological/Oncological Conditions (recognised disability) section of the CA medical report certifying 1 child as having a recognised disability but has not certified the same for the other child.

CA has been granted for 1 child and rejected for the other child. Medical advice is sought from the HPAU to make sure the correct decision is made regarding this condition.

Carer appeals decision within 13 weeks and provides a new THP professional questionnaire, with a qualifying LoRD condition.

HPAU confirms that both children satisfy the 'Haematological/Oncological Conditions' section of the List of Recognised Disabilities.

In this example CA can be granted from the date of claim using the latest medical report as the recognised disability existed at the time the claim was lodged.

Example 3

Carer claims CP and lodges claim and medical report. Claim is processed 3 months later. CP rejected due to non-qualifying DCLAD.

Carer appeals decision within 13 weeks and provides a new THP professional questionnaire, and THP confirms child has just been certified as terminally ill.

In this example CP can be granted from the latter date using the latest medical report. This is because the terminal illness did not exist at the time the original claim was lodged.