Medical Justification Letter - Broda 785 Chair

Published: 04 September 2008

785 Medical Justification [Word Document 29kb]

Patient Name: ______________________  Facility: __________________________

Diagnosis/Functional Description: 

______________ is a 90 year old female resident, who suffers from Chronic Pain.
She has a previous fracture of her right Femur. She requires constant repositioning, elevating of her feet and legs in bed. When not in bed, ___________ is confined to a wheelchair. She does not tolerate any seating system of the wheelchair, but the Broda wheelchair Model 785, that has unique seating surface that will contour to _____________’s body. The Broda chair will help her spend more time out of bed and socialize with other residents.

_____________ was recently evaluated for use of a Broda Model 785 Tilt in Space Positioning Chair. The Broda chair has 38 degrees of infinite tilt capability. When
positioned in the Model 785 and placed in full tilt, ____________ is able to
maintain proper pelvic alignment which contributes to her proper positioning.
The Broda chair also has 90 degrees of infinite recline, which enables the staff to
recline her when she is tired, reducing potential for skin break down or irritation.
Trandelenburg positioning is only available on Model 785 and it will help with her
Congestive Heart Failure.

The Broda Model 785 has a documented low interface pressure seating surface, which is called Comfort Tension Seating™ System. We feel that ___________ will benefit
only from this Broda 785 chair, it will help her stay out of bed for a longer periods of time. This surface will be great benefit to her, with regards to her chronic pain and previous Femur fracture.

The Broda 785 has swing away removable armrests and sides which aids with transfers from bed to chair due to her Diabetes. It also has an infinitely adjustable split flip down footrest which will allow the staff to elevate her feet which is good for blood flow.

This Broda chair is custom sized for her with seat depth of 18.5” to properly fit
____________’s long legs from hips to knees. Our conclusion is that it will contribute
to a more favorable outcome for her both physically and cognitively. This custom
specific Broda wheelchair will be built to accommodate ___________’s requirements.

Signed: _________________________     Date:_______________________