Prosthetic Limb Services
The following Prosthetic Limb Services (PLS) forms and clinical criteria are available for general use:
Forms
- Discretionary Form - Upper & Lower Limb Form (PDF)
- Interim Prosthesis Form (MS Word)
- Interim Prosthesis Form (PDF)
- Minor Repair Voucher (PDF)
- Outcome Review Form - Knee (PDF)
- Outcome Review Form - Combined (PDF)
- Primary Prosthesis Form (MS Word)
- Primary Prosthesis Form (PDF)
- Replacement or Major Repair Form (MS Word)
- Replacement or Major Repair Form (PDF)
- Prosthesis Evaluation Form (PDF)
Clinical Criteria
Accreditation Guidelines
Funding Guidelines
Components List
EnableNSW funds a wide range of prosthetic components for use in prosthetic limbs. For more information about components on the list and whether they are suitable for you, we recommend that you speak with your Prosthetic Service Provider.