This is a sample of a letter that we use, we edit as needed.
May 15, 2009 Dr. John Doe 1111 Missing Lane AnywhereNY12345
Dr. Doe,
Our Records indicate that your patient, John Smith, is requiring an initial Certificate of Medical Necessity (CMN) dated 5/14/2009. The following information was given to us at the time of need.
The estimated length of need for oxygen therapy is 99 Mos.
The patient was diagnosed with 428
The most recent oxygen saturation test we have on file was taken on 5/11/09and the result was 78%. The test was performed on room air while the patient was resting. If there is a more recent test, please provide that information.
The highest oxygen flow rate prescribed is 3 lpm
The patient’s oxygen therapy was prescribed as continuous.
Please make certain that the above medical information is consistent with the patient’s medical record. Please complete and sign the attached CMN. In particular, please be sure that you provide all information requested in Sections B and D of the CMN. We are prohibited from completing these portions of the CMN. Once completed and signed, please fax the CMN to our office at 123-456-7890.
If you have any questions, please feel free to contact me at 012-345-6789 x100. We thank you for the opportunity to serve your patient.
Sincerely,
CMN Cover Letter
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