![]() ![]() ![]() _currently suffers from C5 ASIA A tetraplegia, overall weakness of his upper extremities and absent volitional movement of the trunk and lower extremities, balance impairments, decreased functional mobility (requiring maximum assist for all bed mobility, transfers, etc.)Ģ, impaired posture, and decreased sensation. Prior to his injury, _was an active, healthy individual. _ presented with a cervical spinal cord injury following a motor vehicle accident on April 10, 2008. _ is a 24-year-old male who is receiving intensive outpatient physical therapy services at the _ _Center for Spinal Cord Injury in _. 15” Tall Mid Thoracic Back 18-20 W Posterior: Mid thoracic height with posterior/lateral support and extended mounting hardware: will provide the patient with appropriate back support given his level ofġ SAMPLE LETTER OF MEDICAL NECESSITY FOR POWER ASSIST LETTER of MEDICAL NECESSITY Date: January _, _ Patient Name: x DOB: Diagnosis: C5 American Spinal Injury Association (ASIA) A tetraplegia Equipment Requested: Manual Wheelchair (w/c) with Emotion (Power Assist) Wheels To Whom It May Concern: Mr. _currently suffers from C5 ASIA A tetraplegia, overall weakness of his upper extremities and absent volitional movement of the trunk and lower extremities, balance impairments, decreased functional mobility (requiring maximum assist for all bed mobility, transfers, etc.)Ĭhest Strap, Elastic, Large: required to provide safe positioning in the w/c over uneven terrain and during transport. SAMPLE LETTER OF MEDICAL NECESSITY FOR POWER ASSIST LETTER of MEDICAL NECESSITY Date: January _, _ Patient Name: x DOB: Diagnosis: C5 American Spinal Injury Association (ASIA) A tetraplegia Equipment Requested: Manual Wheelchair (w/c) with Emotion (Power Assist) Wheels To Whom It May Concern: Mr. Example: dental hygienist Search SAMPLE LETTER OF MEDICAL NECESSITY FOR E.MOTION … ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |