Sample Letters of Medical Necessity

The following are samples of Letters of Medical Necessity that Dr. Bach uses for justifying intervention, equipment and training needs. You can also create your own sample letter in the format Dr. Bach utilizes.

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ALS - Amyotrophic Lateral Sclerosis

53-Year-Old Woman (PLV-100, Oxymeter, CoughAssist)

64-Year-Old Man (PLV-100, Oxymeter, CoughAssist)

CMD - Congenital Muscular Dystrophy

24-Year-Old Man (PLV-100, Oxymeter, CoughAssist)

DMD - Duchenne Muscular Dystrophy

16-Year-Old Boy (PLV-100, Oxymeter, Access to CoughAssist, Ambubag)

18-Year-Old Man (Oxymeter, Access to CoughAssist)

MMD - Myotonic Muscular Dystrophy

49-Year-Old Woman (PLV-100, Oxymeter, CoughAssist)

SMA1 - Spinal Muscular Atrophy Type 1

9-Month-Old Girl (BiPAP-ST, Oxymeter, CoughAssist, Ambubag, Chest Percussor, Suction)

Letters of Medical Necessity
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