Medical Justification Letter - 35C Chair
Published: 04 September 2008
Patient Name: _______________________ Facility: __________________________
Diagnosis/Functional Description:
- Severe contractures
- Leaning to left side
______________ is a male resident who has several contractures and has difficulty tolerating any seating surface. The Broda model 35C has a unique seating surface that will contour to ___________’s body.
This Comfort Tension Seating™ surface will reduce pressure and allow for air flow which __________ can tolerate, allowing him to remain out of bed for an extended period of time.
The unique strapping on the Broda 35C will help him with his poor circulation caused by his contractures and will reduce pressure to the area. The unique contracture sling feature replaces the footrest/legrest on the chair and is depth adjustable to accommodate __________’s knee contractures. The contracture sling can be adjusted for his contractures and will facilitate good blood flow and reduce any pressure on his legs. This will also allow _________ to remain out of bed for a longer period of time as his legs will be comfortable and supported while resting on the contracture sling.
Broda can add extended shoulder bolsters or optional lateral supports to help prevent his leaning on the left side and helping to prevent falls.
The 35C has 25 degrees of infinitely adjustable seat tilt allowing for optimal spinal alignment. It also has swing away and removable arms allowing the transfer of ___________ from bed to chair go smoothly for him and the staff.
On conclusion, the Broda 35C will contribute favorably to ________________’s condition. The therapy department feels the above chair will meet _______________’s current and future needs and assist with preserving his health/life and help prevent future impairments and will be obtained for his contingent upon your approval.
Signed: ____________________________________ Date: _______________________