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Tips for Requesting and Sending a Medical Necessity Letter Includes detailed identification for both patient and provider. Details the diagnosis, treatment, and relevant medical history. Explicitly affirms medical necessity and lack of a better or less costly alternative, citing supporting data and research if needed.

I am writing on behalf of my patient, [Patient Name], to document the medical necessity to treat their [Diagnosis] with [Product Name]. This letter serves to document my patient's medical history and diagnosis and to summarize my treatment rationale. Please refer to the [List any Enclosures] enclosed with this letter.

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. On behalf of the patient, I am requesting approval for use and subsequent payment for the [TREATMENT].

A summary of the patient's diagnosis and the indication for the medication being prescribed. Be sure to include: The diagnosis code(s), the severity of the patient's condition, prior treatment(s) including the duration of each and the patient's response to each treatment.

A durable power of attorney becomes effective when signed and remains in effect until the person granting the power either revokes it or dies. A durable power of attorney differs from a traditional power of attorney in that it continues the relationship beyond the incapacity of the principal until death.

34-6A-105. A power of attorney must be signed by the principal or in the principal's conscious presence by another individual directed by the principal to sign the principal's name on the power of attorney.