Letters of Medical Necessity Rifton Adaptive Tricycle Letter of Medical Necessity
View a sample letter of medical necessity for the Rifton Adaptive Tricycle. 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 (2.3 MB)