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Letters of Medical Necessity
Rifton TRAM Sample LMN: Adult homecare
Components of a Letter of Medical Necessity for use in the homecare of an adult. Note: Every reasonable effort has been made to verify the accuracy of the information. However, sample letters of medical necessity are not intended to provide specific guidance on how to apply for funding for any product or service. Health care providers should make the ultimate determination as to when to use a specific...
Letters of Medical Necessity
Rifton TRAM Sample LMN: School-based therapy
Components of a Letter of Medical Necessity for use in school-based therapy of an adolescent. Note: Every reasonable effort has been made to verify the accuracy of the information. However, the sample letter of medical necessity is not intended to provide specific guidance on how to apply for funding for any product or service. Health care providers should make the ultimate determination as to when to...
Letters of Medical Necessity
Rifton TRAM Sample LMN pdf: Homecare setting
View a sample letter of medical necessity for the Rifton TRAM intended for use in the habilitation or homecare of an elderly adult. It is not intended to provide specific guidance on how to apply for funding for any product or service. Health care providers should make the ultimate determination as to when to use a specific product based on clinical appropriateness for a particular patient and applications to any funding source must accurately reflect the facts unique to individual applications.
Download PDF (1.5 MB)
Letters of Medical Necessity
Rifton TRAM Sample LMN pdf: School-based therapy
View a sample letter of medical necessity for the Rifton TRAM. It is not intended to provide specific guidance on how to apply for funding for any product or service. Health care providers should make the ultimate determination as to when to use a specific product based on clinical appropriateness for a particular patient and applications to any funding source must accurately reflect the facts unique to individual applications.
Download PDF (1.5 MB)