Sample Justification to Support LMN

This tool is to assist in justifying items in a letter of medical necessity (LMN) and will provide sample justifications for Permobil products.

Please NOTE: Specific client information should be added by the prescribing medical professional to complete the letter of medical necessity.

A Sample LMN and Examples of complete letters are available in the Funding section of the Permobil website.

Once you check all necessary component sections, click “Show Generated Letter” and copy/paste into your letterhead and edit as necessary.

 

Generated letter

Please choose the BEST Introductory statement for your client

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Scooter Statements (for Medicare requirements)

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Combined Base with Seating System

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If Combined Base and Seating System is selected, skip sections "Base" and "Seating System."

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Select Base

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Seating Systems

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Base Options

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Permobil base options:

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Additional Base Features

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Joystick Options

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Power Seat Functions

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Seating System Options

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Armrest Options

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Legrest Options

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Accessories

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Alternative Drive Systems

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Alternative Drive Accessories

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