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Justice Center for the Protection of People with Special Needs

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  2. » Outreach and Education
  3. » Assistive Technology (TRAID) Program
  4. » AT Funding Toolkits
  5. » Standing Wheelchairs Funding Request Checklist

Sample Supporting Letter of Medical Justification for a Standing Wheelchair

Document: 

Sample_Supporting_Letter_Standing_Wheelchair.pdf

PDF icon Sample_Supporting_Letter_Standing_Wheelchair.pdf

Agency Directory

  • Surrogate Decision-Making Committee (SDMC)
    • Introduction to Surrogate Decision-Making Committee (SDMC)
    • SDMC Forms
      • Forms Needed for Major Medical Treatment
        • Certification on Capacity for Major Medical Treatment (210)
        • Certification on Need for Major Medical Treatment (220A)
        • Declaration for Major Medical Treatment (200)
        • Supplemental Medical Information (220B)
      • Sample Forms Needed for Major Medical Treatment
        • Sample - Declaration for Major Medical Treatment (200)
        • Sample - Certification on Capacity for Major Medical Treatment (210)
        • Sample - Certification on Need for Major Medical Treatment (220A)
        • Sample - Supplemental Medical Information (220B)
      • Forms Needed for End of Life Care
        • Declaration for End of Life Care (300)
        • Certification on Capacity for End of Life Care (310)
        • (320AB) Attending Physician and Concurring Physician Certification for End of Life Care
        • Supplemental Medical Information (330)
      • Sample Forms Needed for End of Life Care
        • Sample - Declaration for End of Life Care (300)
        • Sample - Certification on Capacity for End of Life Care ((310)
        • Sample - Attending and Concurring Physician Certification for End of Life Care (320AB)
        • Sample- Supplemental Medical Information (330)
      • Sample MOLST Checklist with 380-A
    • Instructions for Opening an Encrypted Email Message from the Justice Center
    • Frequently Asked Questions
      • Information for Provider Agencies
      • Information for Prospective Volunteer Panelists
        • Panel Member Application Form
  • Office of Communications
    • Press Releases
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  • Office of General Counsel
    • Criminal Background Check Unit
  • Office of Incident Reporting and Investigations
    • Office of Incident Reporting
      • Report Abuse
        • Web Intake Incident Form
        • Mobile Incident Reporting App
      • Report a Death
        • Clarification of Reporting and Investigating Deaths
        • Instructions for Completing a Report of Death Form to the Justice Center
        • Death Report Form
    • Office of Investigations
      • Death Investigations Unit
      • Training for Investigators
        • Training Opportunities
    • Out of State Placements Unit (OSP)
    • Office of Investigations Assistant Chief Contact Information by Region
  • Outreach and Education
    • Adult Home Advocacy
    • Assistive Technology (TRAID) Program
      • AT Funding Toolkits
        • Standing Wheelchairs Funding Request Checklist
          • Sample Letter of Medical Justification for a Standing Wheelchair
          • Sample Supporting Letter of Medical Justification for a Standing Wheelchair
          • Pediatric Power Wheelchair with Accessories
          • Sample Letter of Medical Justification for Pediatric Power Wheelchair
          • Sample Supporting Letter for Medical Justification for Pediatric Power Wheelchair with Accessories
      • AT Training
      • Early Intervention Program Activities
      • Money Follows the Person (MFP)
      • Interagency Partnership on Assistive Technology (IPAT): TRAID Advisory Board
      • TRAID Center Locations by Region
      • getATstuff: Assistive Technology Exchange in New England & New York
    • 2017 Justice Center Code of Conduct
    • Individual and Family Support Unit
      • Contact the Individual and Family Support Unit
      • FAQ
      • Reporting and Investigations Process Explained
      • Trauma Stewardship:
    • Information, Referral and Technical Assistance
    • Ombudsperson for Individuals with Developmental Disabilities Program
    • Forensic Oversight Unit
  • Office of the Special Prosecutor
    • Prosecutions Unit
    • Administrative Appeals Unit
      • Adjudication
      • Administrative Appeals Process Chart
      • Frequently Asked Questions-Administrative Appeals Process for Substantiated Cases of Abuse and Neglect
    • District Attorney Resources
      • Daily Abuse and Neglect Case Advisory
      • Monthly Abuse and Neglect Case Outcome Advisory
      • Instructions for Opening an Encrypted Email Message from the Justice Center
      • Justice Center DA Notifications Webinar
  • Prevention and Quality Improvement
  • SDMC Panel Member Handbook

Justice Center for the Protection of People with Special Needs

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