NDIS FUNDING REQUEST LETTER TEMPLATE
NDIS funding request letter template for Arco Brush
A template an OT, participant or support team can adapt when documenting functional barriers and the practical reason Arco Brush may be considered.
This is a template to adapt, not clinical advice. The practitioner or requester is responsible for its content. It does not state or imply that funding will or should be approved.
FULL TEMPLATE TEXT
Copy and adapt the wording below
[Date]
To whom it may concern,
Re: [Participant full name] | NDIS number: [Participant NDIS number] | Plan management type: [self-managed / plan-managed / NDIA-managed]
I am writing in relation to [Participant name] and their daily personal-care routine, specifically oral care.
Functional barriers to oral care
[Participant name] experiences functional barriers that affect their ability to complete a standard toothbrushing routine. These may include [grip difficulty], [reduced dexterity], [coordination difficulty], [fatigue], [sensory tolerance], [difficulty completing the routine consistently], and/or [need for carer assistance].
Current support required
At present, [Participant name] requires [verbal prompting / visual prompts / supervision / setup assistance / physical assistance / carer-supported brushing] to complete oral care. The level and timing of support required is: [describe current support].
Strategies previously trialled
Strategies previously trialled include [standard toothbrush], [adapted grip], [electric toothbrush], [visual prompts], [timers], [carer-assisted routine], and/or [other strategies]. These strategies were insufficient because: [describe why they did not adequately address the functional barriers].
Relationship to participant goals
The requested item relates to [Participant name]'s stated goals around personal care, routine completion, participation in daily living activities, and/or supported independence. Relevant plan goals include: [insert plan goal wording].
Requested item and supplier
Requested item: Arco Brush Starter Kit. Supplier: Arco Brush. Cost: AUD $395. Replacement consumable: Arco replacement mouthpiece. Replacement consumable cost/frequency: AUD $25; recommended replacement about every 6 months.
How the item will be used and maintained
The item would be used as part of [Participant name]'s daily oral-care routine. It would be [used / set up / supervised / cleaned / charged / stored / maintained] by [participant / family member / support worker / carer], with support as follows: [describe practical routine].
Neutral funding note
This letter documents functional need and the practical reason the item may be considered. Funding decisions remain individual and are made according to the participant's plan, evidence, budgets and NDIA requirements.
Yours sincerely,
[Name]
[Role / relationship to participant]
[Provider or organisation, if applicable]
[Contact details]
[Signature]