Medical Justification Letter : At A Glance

Start Your Letter With an Introductory Sentence.

I am writing this letter in support of John Doe's request for a____________.

What Are Your Professional Credentials?

• Your authority to make the following statements; license, education, years practicing

What Is Your Professional Relationship to This Patient?

• How long you've worked with this person
• What services do you provide
• How often

What Is The Patient's Diagnosis and Prognosis?

• Primary and secondary

Describe The Current Device and How It Is Failing to Meet Patient's Needs.

• Don't forget homeopathic remedies like duct tape and clothes hangers

Describe The Requested Device, Including, If Necessary How It Meets The DME Definition.

How Will The Requested Device Meet the Patient's Medical Needs?

Would other medical personnel like to contribute?

How Is This Device the Least Costly, Equally Medically Effective Device?

• Other devices considered
• Warranties, guarantees, etc.

Prepared by Neighborhood Legal Services, Inc. - Updated January 2005
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