Sample letter of medical necessity - Frank Mobility Systems
Sample letter of medical necessity - Frank Mobility Systems
Sample letter of medical necessity - Frank Mobility Systems
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Justification for Prescribed Manual Wheelchair:Allow alteration in pressure distribution for skin integrityAllow increased sit time by decreasing discomfort and fatigue ADL/Safety in FeedingADL/Safety in feelingLightweight frame to permit independent management <strong>of</strong> wheelchair(indoors/outdoors)Lightweight rigid frame to permit transportationNarrow wheel base for increased accessibility in community and bathroomsDurabilityAllow optimal wheel access for functional propulsionMaintain optima postural alignmentInsure patient’s safetyThe above recommendations were made after careful considerations <strong>of</strong> thispatients needs. Please do not hesitate to call if you need further assistance.Your prompt attention to this matter would be greatly appreciated.Submitted,____________________Seating & <strong>Mobility</strong> SpecialistAffirmed,_______________________Physician:RESNA Certified ATP:_____________________________________________Signature/NY Lic # Signature/ Lic #NPI #NPI#
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