Letter of Medical Necessity

A Letter of Medical Necessity is a narrative from a physician stating clearly why (medical reasons) a patient needs the orthotic device. The letter should include:

Practitioner's name, mailing address, and other contact information in letterhead, if possible
Patient's name, date of birth, diagnosis, and evaluation date
Reasons for bracing: the functional challenges the patient has that you are hoping to address with this orthotic device
Specific orthotic style choice and reasons why you chose it
Anticipated functional improvement after bracing
Duration of this expected functional improvement
Signature of practitioner

Sample Letter of Medical Necessity

If you are unable to obtain a Letter of Medical Necessity, please send a copy of the patient notes.

 Patient Notes Template


Note— It is useful to include specific technical information about the orthosis. You can find this information at cascadedafo.com under the Products topic. To find the specific orthosis, scroll down.