Acknowledgement of Accessory Limitations Error There was an issue retrieving information. Please refresh your page and try again. If you've made several attempts without success, please contact your Documentation Specialist for assistance. It is important to Lingraphica that all clients are fully informed and satisfied with their Lingraphica communication devices. For clients who have a diagnosis that may impact movement of their upper extremities, Lingraphica wants to ensure that an informed decision is made when electing to purchase a Lingraphica device. Lingraphica devices do not support alternative accessories such as eye gaze, switch scanning or lower body access methods. These accessories are often desired if/when access to the device is not obtainable due to inability to use hands/arms for activating communication devices. Although these accessories are available on devices made by other manufacturers, such as Tobii Dynavox, it is not uncommon for clients to choose Lingraphica devices due to their simplicity, user-friendly interface, and portability. Clients who are not able to activate the device with their upper extremities may use communication partner scanning for access to the device. If diagnosis is ALS, many ALS Foundation chapters have a lending library. If a client/SLP is selecting to purchase a Lingraphica device and may need alternate access methods in the future, it is recommended that they call the local ALS Foundation to see if there are devices with eye gaze accessories available for loan. This acknowledgment is assurance that the client purchasing the device has been informed of the following: Lingraphica devices support standard mouse/keyboard and the following stylus variations: ball grip, t-grip, flexible, flexible with strap, weighted and extended. Medicare and most insurances will only purchase one (1) communication device every five (5) years for beneficiaries. Tobii Dynavox, PRC, Control Bionics and other vendors support alternate input devices, and the client has been encouraged to explore that option. Communication devices may not be returned to Lingraphica if access with upper extremities becomes unsuccessful. Lingraphica will provide support for learning communication partner scanning if the client cannot access the device with their upper extremities. Signature* Reset signature Signature locked. Reset to sign again Date* MM slash DD slash YYYY Printed Name* Relation to Client*Patient(Self)SpouseSignificant OtherParentChildFriendPower of AttorneyGuardianOtherOther Diagnosis*