Letter of Medical Necessity
Formal letter establishing medical necessity for equipment, services, therapy, or accommodations, linking diagnosis and functional limitations to the request.
Included on every plan, including Free.
- Choose this templatePick it when you start a visit, or make it your default.
- Record the visitIn the room, over telehealth, or by dictation afterwards.
- Review, edit and signThe draft arrives in these sections, ready for your review.
What’s in this template
10 sections, in the order they appear in the finished document.
- 1HeaderAuto
- 2SalutationParagraph
- 3Introduction & RequestParagraph
- 4DiagnosisBullets
- 5Clinical BackgroundParagraph
- 6Functional LimitationsBullets
- 7Why This Is Medically NecessaryParagraph
- 8Duration of NeedParagraph
- 9ClosingParagraph
- 10SignatureAuto
“Auto” sections use whichever format reads most clearly for what was discussed: prose or a list.
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General
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