Sample Materials
Template for requesting letters of support for
your application for AT funding

One type of documentation you will need as you apply for funding are letters of support from professionals you have worked with. This may include physical therapists, occupational therapists, rehabilitation counselors or other people who know you well. The letters of support should help the funding source understand what your needs are and the specific impact that the AT device or service you are requesting will have on your life.

Below is a sample letter that you can use as a starting point for requesting letters of support from key professionals.
Dear [name]:

We are trying to get funding for [person's name] for [name of device].

As a professional who has worked closely with this person, your input is essential in this effort. The third party payment agency must receive justification from the various professionals who work with this person in order to determine whether they will cover the device as a medical necessity. Please write a letter/report addressing the issues in the outline below. This letter should be addressed "To Whom It May Concern" and returned to me at [address].

1. How long have you worked with this client?
2. In what capacity have you worked with this client?
3. What medical diagnoses have been made for this client?
4. What is the client's current level of functioning?
5. What specific need(s) of the client can be addressed by an AT device or service? Please give examples.
6. What AT device or service would benefit this person?
7. How would the AT device or service benefit this person? Please give examples.
8. What is the client's prognosis, with and without the AT device or service?
9. If the client has used the device or service on a trial basis, what was the outcome?

Thank you. We will keep you informed of our progress with this effort.

Sincerely,



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