AAC >> Sample AAC Reports

Here you will find sample augmentative-alternative communication evaluation reports / funding requests. These reports may provide assistance for your own report writing. However, it is strongly advised that you check the guide lines for funding with each insurance company you are submitting funding requests to. The device manufacturer’s funding department is the best resource for ensuring your report and funding packet will contain the most up to date requirements. Speech Generating Device (SGD) funding requests must be submitted by a qualified speech-language pathologist (who is licensed and certified by the American Speech and Hearing Association) and must be accompanied by a complete funding packet including but not limited to: a physician’s prescription for the SGD, copies of ALL the client’s insurance cards (front and back), a current list of medications, client information form, assignment of medical benefits form, client bill of rights, written concurrence from school if client is a student in the public schools, statement of non-conflict of interest. All of these forms can be obtained through the funding department of the device manufacturer (check the manufacturer’s website). Funding packets must be submitted to the funding department of the device manufacturer and it will be submitted to the insurance company via the device manufacturer.

  • Sample Adult AAC Evaluation

  • Here you will find a sample adult AAC evaluation report/funding request for a client with a diagnosis of Cerebral Palsy. This report is based on an actual report that resulted in Medicaid funding for the purchase of the recommended voice output devic... read full details


  • Sample AAC Report for ALS Client

  • Here you will find a sample adult AAC evaluation report/funding request for a client with a diagnosis of Amyotrophic lateral sclerosis (ALS), for the purchase of the recommended voice output device. This report may provide assistance for your own rep... read full details