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I am writing on behalf of my patient, PATIENT NAME, to REQUEST PRIOR AUTHORZATION/DOCUMENT MEDICAL NECESSITY for treatment with INSERT PRODUCT. The PATIENT NAME has a diagnosis of DIAGNOSIS and needs treatment with INSERT PRODUCT, and that INSERT PRODUCT is medically necessary for him/her as prescribed.
Because of my disability, I need the following accommodations: LIST ACCOMMODATIONS. A medical provider has prescribed this accommodation for my disability. I would like to meet with you to discuss these and any other accommodations that will enable me to have an equal opportunity to live in and enjoy this residence.
A letter of support from your doctor can go a long way toward qualifying for disability benefits. Not only does it support the information that's found in your medical records, but it summarizes the information into a much more easily digestible format.
Write "Dear Dr." and the doctor's last name on the top line of the letter itself. For example, begin your message with, "Dear Dr. Williams." Use this prefix for those with doctorates, too, unless the person has specifically told you to avoid doing so.
If applicable, the LOMN should include the following as a supplement or appendix:A drug's full Prescribing Information.Relevant medical literature regarding the use the treatment for the patient's specific diagnosis. Standard of care from medical society.Supporting lab/test results.Supporting progress notes.10 July 2019