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Writing Medical Necessity

Module 5: Admissions, Eligibility, and Medical Necessity ยท Lesson 3 of 3

A necessity statement is a logical chain, not a paragraph of jargon.

The chain: qualifying diagnosis leads to specific functional impairments, which prevent role functioning, which rehabilitation interventions are designed to address, and without which the participant is at risk of a defined negative outcome.

Keep the risk statement honest and concrete: loss of housing, return to hospital, loss of custody, job loss. Avoid speculative catastrophizing, which reviewers discount.

Key takeaways

  • Diagnosis to impairment to service to risk without service
  • Concrete risk beats dramatic risk
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