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.