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The wonder chairs for those with disabilities.

Letter Of Medical Necessity – Chill-Out Chair

Date: To Whom It May Concern: I am the pediatrician for child’s name (DOB). Child’s name has the following diagnoses: Cerebral Palsy (ICD code) Secondary Diagnosis (ICD code) Third Diagnosis (ICD code) Fourth Diagnosis (ICD code) Additional Diagnoses added with qualifying ICD codes as required I am requesting an alternative seating device for child’s name given her complex and severe medical condition. Child’s name is nonverbal, has minimal communication and is fed...

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Letter of Medical Necessity – Adaptive Mobility Device

Date Re: Patient’s name DOB: To Whom It May Concern: Patient’s name is a 3 year-old male with a history of cerebral palsy, spastic dystonic quadriplegic type (ICD 343.9), with Gross Motor Function Classification Score of 4. Because of patient’s name’s condition, he cannot safely use regular mobility products. I am requesting a Freedom Concepts’ mobility device that is custom designed for his use. By providing patient’s name with an adaptive device, he can benefit from the...

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Justification Letter – Adaptive Mobility Device

Date To Whom It May Concern: My name is ________________________ and I am the Developmental Pediatric Practitioner at _________ and I am writing on behalf of my patient, _______________________. Patient’s name is a special young child with the following diagnoses: Chromosomal Anomalies (Cyclin-dependent Kinase-like 5 or CDKL5) 758.9, Autistic Disorder (299.0), Epilepsy and Recurrent Seizures (345.90) Asthma (493.90) Developmental Coordination Disorder (315.4) and Profound...

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Justification Letter – Adaptive Mobility Device

Date To Whom It May Concern; Patient’s name is a 9 year old girl who receives weekly physical therapy at ___________  for problems associated with her diagnosis of Left Hemiplegia Cerebral Palsy secondary to prematurity and a grade III IVH. Patient’s name was discharged from physical therapy with a shift to only a home program. Patient’s name plans to return to therapy during the summer break from school. Patient demonstrates a functional asymmetry, proximal muscle...

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