Printable Medical Forms
Letter Of Medical Necessity Medical Form


{Physician Name}

{address}

{city, state, zip}

{phone}

 

{date}

 

 

To whom it may concern,

 

Please be advised that the {medical device such as CPAP, BiPAP, oxygen tank, etc.} carried by traveler {Name} is medically necessary, and the device is in full compliance with all airline safety regulations. Additionally, {other information such as pressure setting, accessories, etc.}.

 

{Name} is my patient at {XYZ Sleep Disorder Center}. This device is medically necessary so that {Name} will be {able to breathe} They have been diagnosed with {obstructive sleep apnea}.

 

This {machine/device} is fragile and should be transported personally by the patient. It is not to count against any airline allowance for carryon luggage or personal items.

 

If there are any questions, don’t hesitate to contact my office at {contact information}.

Sincerely,

 

{Physician Name}

 











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