Sample Letter
| Today, 2000
Patient: This Client RE: Letter of Medical Necessity This Client is a twelve year old boy who has a diagnosis of 007 Syndrome which results in the following severe impairments: profound apraxia of speech (a neurogenic speech disorder which adversely affects his ability to program the positioning of his speech muscles and the sequencing of muscle movements which impair his capacity to produce phonemes for the formulation of speech), bilateral atresia of the external ear canal resulting in moderate bi-lateral conductive hearing loss (which cause him to be unable to hear some speech sounds) , generalized fine motor difficulties affecting the quality of large motor movements and resulting in poor coordination, and delayed intellectual development placing him in the mildly retarded range. Due to these medical difficulties, he is nonverbal and unable to communicate his medical needs via the modalities of writing or signing. This Client has no means of communicating critical information concerning medical, emergency and care-giving situations to physicians, therapists, parents and significant others in his environments of home and community. Although he has attempted to learn and use other augmentative communication devices in the past, they have been unsuccessful due to the limitations of these previous devices. Recently a Perfect System communication device was loaned to This Client on a trial basis. He was able to access the device and understood the power and capability that it gave him in communicating his needs. The size and weight of the system, however, made portability difficult. Because of his neurological problems, the prognosis for him developing oral speech is extremely low. He needs a speech prosthesis to enable him to overcome the effects of 007 Syndrome. The recommended system is the Perfect System. With a device such as the Perfect System, he would be able to express all communication needs including such medical needs as indicating feelings of illness, pain, and discomfort as well as the location of his pain or discomfort. Without this capability, he is at risk for serious medical problems. Therefore, the Perfect System with a carrying case, and infrared connections are a medical necessity. The symbol system and keyboard will allow him quick access to generate verbalizations and express his thoughts, needs and ideas in medical, emergency and care-giving situations. The voice output aspect of this device is necessary to notify those in his immediate environment so that they will be able to immediately understand and respond to his needs. Consequently, the outcome is expected to be that appropriate health care can be provided through the Perfect System. Sincerely, Hillary Clinton, MA, CCC-SLP, Recommended Equipment: The Perfect System $5995.00 |