Medical Justification Letter - Broda Pedal Chair

Published: 03 September 2008

Patient Name: _____________________  Facility: ________________________

Diagnosis/Functional Description: 

• Dementia
• Alzheimer’s
• Depressive Disorder
• Not Ambulatory
• Disoriented

______________  is a 94 year old female resident who has depressive disorder which enables her to be aware of things around her.

The Broda wheel chair Model 48 Pedal Chair has a unique seating surface that will contour to ____________’s body.

This Comfort Tension Seating™ surface reduces pressure and allows for air flow which ______________ can tolerate, allowing her to remain out of bed for extended period of time.

Broda can build a seat width of 20” and seat depth of 17” just for ___________’s body to keep her properly positioned and stable.

The Broda Pedal Chair, Model 48, has 18 degrees of infinitely adjustable seat tilt allowing for optimum spinal alignment. When it is full tilted, __________ presents less risk of getting out of her chair and falling.

In Broda Pedal Chair, ____________ will be able to move about the facility thus improving her independence. The optional elevating swing away footrests enable the staff to elevate her feet, facilitating good blood flow.

On conclusion the Broda Pedal Chair, Model 48 Tilt in Space will contribute ____________’s physical recovery.

This Broda wheel chair will be built to accommodate ______________’s  requirements.

Signed: _____________________  Dated: _____________________