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Get Inspired By Drive Gait Trainer Letter Of Medical Necessity (Sample) 2017-2024

Ry Insurance: Medicaid Policy #: 987654321 DOB: 01/01/2005 Duration of Need: Lifetime Diagnosis: Cerebral Palsy, Spastic Quadriplegia, Developmental Delay Height: 4 10 Weight: 73 lbs. The following is medical necessity justification for a gait trainer for JT. JT is a 12 year old male with a primary diagnosis of Cerebral Palsy since birth. JT is non ambulatory due to spasticity in all four extremities and overall weakness. JT cannot sit without support. He currently uses a wheelchair with c.

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