THE DOCTOR LETTER & MEDICAL JUSTIFICATION FORM (MJF)
All MA97 request use the same Doctor Letter and Medical Justification From (MJF) template for each request. Representatives simply have to update the letter for each request.
The following areas need to be updated on the Doctor Letter:
- The date.
- The consumer’s full name.
- The consumer’s date of birth.
- The doctor’s full name.
- The requested items description, the extra and total units per month, and the total write up.
- The toal units is the MA97 units in addition to what the consumer already receives.
- (Ex: 30 units per month, 90 total units per month)
- The total write up just explains the units to the doctor.
- (Ex. 60 already receiving thru PA/MA + 30 thru MA97)
- The employee who is completing the form’s information.
- The toal units is the MA97 units in addition to what the consumer already receives.
A copy of a Doctor Letter has been included at the end of this section of the procedure, with the highlighted areas to be completed.
The following areas need to be updated on the Medical Justification Form
- The consumer’s full name.
- The consumer’s date of birth.
- The doctor’s address.
- The doctor’s phone number.
A copy of a Medical Justification Form has been included at the end of this section of the procedure, with the highlighted areas to be completed.
Shown below is a Doctor Letter that has been highlighted for convenience with the areas that needs to be completed:
Shown below is a Medical Justification Form that has been highlighted for convenience with the areas that need to be completed:
After both the Doctor Letter and Medical Justification Form have been printed, representatives must highlight the areas where the doctor must complete for convenience.
Shown below are the areas that should be highlighted for the Doctor Letter:
Shown below are the areas that should be highlighted for the Medical Justification Form:
After printing both the Doctor Letter and the Medical Justification Form, representatives should also put a sticky on the Doctor Letter, to remind physicians to mail back the documentation.