EXAMPLE LETTER #2 OF MEDICAL NECESSITY

To Whom It May Concern:

Dakotah Hughes is a 9 -year old girl with Aicardi Syndrome. She is completely non-ambulatory and requires 24-hour supervision. She is profoundly disabled both mentally and physically. Dakotah now has a need for a safer bed for sleeping at night and resting during the day.

Dakotah has seizures that occur at night when she is in bed and unable to be supervised. During these seizures her arms and legs flail outward hitting whatever surface is next to the bed. Her mother has reported that she had to nail foam to the wall (see attached picture) because Dakotah’s knuckles where scraping against the wall during the seizures causing them to bleed. During these seizures, her body often shifts and her mother stated that she comes in many mornings to find one of Dakotah’s legs hanging off the bed or caught between the bed and the wall (see attached pictures). Dakotah’s current bed is not able to adequately protect her during a seizure and there is also a high probability that she could fall out of the bed. Due to her inability to speak, she cannot request help when/if these things occur.

Dakotah is already (state how tall she is) tall and will continue to grow. The twin size bed that she is currently using is not an adequate size bed for her in regards to width (especially during her seizures). (Due to the rapid and unpredictable, sometimes violent movement during seizures, it is necessary that she be in a larger bed, at least 48 inches wide) She will be safer and better protected from injury in a full-size bed. Dakotah also needs (a frame that allows mattress articulation to raise her head and/or feet to feed (via g-tube), administer daily medications, and provide positioning. She is not able to stay on pillows and needs to be slightly elevated at night to avoid her respiratory functions being compromised. She also needs the elevation to avoid reflux and aspiration.

The SleepSafe Plus full-size bed will give Dakotah all the safety features that she requires both physically and medically. The full-size mattress will help prevent bruising and injury to Dakotah since she will have more room between her body and the side rails. The full length, adaptable 10 inch safety rails will ensure that she does not fall out bed. The padded rails will protect her extremities during seizures. The mattress articulates to keep her head elevated. Her feet can also be slightly elevated to avoid her body sliding down. The design of this bed will also prevent entrapment of her extremities because there are no gaps between the mattress and side rails/headboard/footboard, even with compression.