Date: October 30, 2017

Re: Regina Phalange

Subject: Letter of Medical Necessity Surehands patient lift.
Physician: Dr. Martin, M. D.
Therapist: Allie Ritchie, MOT, OTR/L

Diagnosis: Left hemiparesis and morbid obesity

Patient history and problem:

Regina is a 64 year old female who suffered a R hemispheric stroke on August 12, 2017 and has
resultant L hemiparesis. Regina is also morbidly obese and is dependent for all functional transfers
including bed to/from wheelchair, wheelchair or bed to her wheeled commode which she is using for her
toileting and also bathing tasks. Client lives in a single level home with her husband who is her caregiver.
Her husband is unable to physically move her due to his on medical conditions. Therefore Regina will
require an automatic patient lift in order to safely perform her ADL transfers.

Recommended Equipment: Surehands patient lift, DMERC code #E1399:

The Surehands lift is a versatile system that allows a patient to access their bed, bath/shower,
toilet, or wheelchair as well as assist with dressing tasks. The lift works by using body supports under the
arm and thighs in order to lift a patient from a surface, accommodating to their size as the process occurs.
The lift can then be pushed or motorized along a track to the desired destination. The lift can be operated
by the patient themselves, or the caregiver, greatly reducing strain on both the patient and caregiver
during functional transfers. The track can be placed anywhere around the home for easier access to
desired areas. Although the Surehands is more expensive than other options, the cost is negated by the
safety benefits.
Other patient lifts include the Hoyer lift which uses a sling and requires the caregiver to move the
patient and the lift in order to transfer the person from one place to another. This lift is not an option for
Regina due to the fact that there is not a sling that will accommodate her size, neither she nor her
husband is able to don the sling, and the fact that her husband is unable to physically move the lift and
Regina together in order to make a safe and successful transfer.

Medical Necessity:
The Surehands system is medically necessary for Regina in order to increase access around her
home and improve functional transfers for self-care tasks. Using the Surehands lift will also reduce the
burden of care on her husband, who is currently unable to provide the physical assistance she requires.
The Surehands lift is the only option for Regina due to her weight, as she is at greater risk for skin
breakdown. Although the Hoyer lift is more inexpensive, the sling will rub against Reginas underside due
to her size, putting her at risk for skin sores. In addition, a Hoyer lift would not properly positon Regina
into her wheelchair to minimize pressure points. Because her husband is unable to physically assist,
Regina will be immobilized into these improper positions, again adding risk for skin breakdown. The Hoyer
lift sling will also cover the underside of Regina, so although she may be transferred onto her bedside
commode, the sling will remain underneath her and create difficulty in pants management for toileting. In
addition, by increasing her access to her bath in the home, she can partake in bathing in a more
appropriate space as opposed to her commode, which will increase hygiene and reduce risk for hygiene-
related infections.

If I can be of further assistance or if there are any other questions about Reginas needs please
contact me, Allie Ritchie, at (801) XXX-XXXX.

Allie Ritchie, MOT, OTR/L