Letters of Medical Necessity Rifton Wave Letter of Medical Necessity
pink Rifton Wave bath chair
View a sample letter of medical necessity for the Rifton Wave Bathing and Transfer System. 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 (634.1 KB)
Letters of Medical Necessity Compass Chair Letter of Medical Necessity
the Rifton Compass Chair - a plastic classroom chair for students with special needs
View a sample letter of medical necessity for the Rifton Compass Chair. 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 (656.1 KB)
Letters of Medical Necessity Pacer Letter of Medical Necessity for School
blue standard Rifton Pacer gait trainer with accessories
View a sample letter of medical necessity for the Rifton Pacer. 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 (576.8 KB)
Letters of Medical Necessity Pacer Letter of Medical Necessity for Homecare
blue standard Rifton Pacer gait trainer with accessories
View a sample letter of medical necessity for the Rifton Pacer. 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 (629.4 KB)
Letters of Medical Necessity Rifton HTS Letter of Medical Necessity
The Rifton HTS Hygiene and Toileting System.
View a sample letter of medical necessity for the Rifton HTS hygiene and toileting system. Download PDF (592.8 KB)
Letters of Medical Necessity Rifton TRAM Sample LMN: Adult homecare
A caregiver using the Rifton TRAM to help an elderly homecare client make a seated transfer into bed.
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
Rifton TRAM telescoping lift column
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 Sample Letter of Medical Necessity for a Rifton Feeding Chair
The following letter was instrumental in gaining funding for a Rifton Activity Chair to be used for feeding purposes.We wanted to share this letter with you in case it can inspire and give you guidance on writing a similar letter of medical necessity for your client. (Back to Feeding Equipment for Special Needs Children by Ann Walsh, MS/CF-SLP) Patient Name: Medical Record Number: Date of...
Letters of Medical Necessity Tips for Writing a Letter of Medical Necessity
A therapist with a clipboard in hand holds a pencil to her mouth as she looks off thinking about what to write
When you need to approach a reimbursement provider you may find the following materials useful: Explaining the letter of medical necessity process- an article in pdf format by Sarah Rollman, MSA, JD. An 11 point checklist in pdf format for writing a successful letter of medical necessity. LMNBuilder: A web tool that helps create letters of medical necessity (free for clinicians). Six Tips...
Letters of Medical Necessity Rifton Activity Chair Letter of Medical Necessity
a Rifton Activity Chair
View a sample letter of medical necessity for the Rifton Activity Chair. 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 (2.2 MB)
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