Letter of Medical Necessity
Patient Name: ________________________________________ Date of Birth: ________________________________________ The Aeroneb GO electronic micro pump nebulizer is designed for the patient suffering from a chronic respiratory condition including but not limited to Chronic Obstructive Pulmonary Disease, Asthma, and Cystic Fibrosis. The nebulizer has been shown to deliver respiratory medication faster, more efficiently, and more effectively than the standard compressor nebulizers currently available (1). In the case of this patient, having a chronic respiratory condition, it is imperative that the person utilize the most effective medication delivery device available in hopes to increase efficacy, and compliance in administering the respiratory medication. In the case of this patient spending a significant amount of time in transport, at athletics and other activities, it is imperative that the person utilize the device that is the easiest to maintain operational battery charge. The Aeroneb GO uses “AA” batteries and does not require an outlet to charge, therefore making it the best portable nebulizer option. 1. Fink JB, Dhand R. Aerosol Therapy. In: Fink JB, Hunt G, eds. Clinical Practice in Respiratory Care. Philadelphia. Uppincott Raven, 1998
Physician Name: ________________________________________________________ Physician Signature: ______________________________________________________ Date: ____/______/______
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