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Medical Necessity Template Letters

Recognizing the fact that clinicians and suppliers may be asked to provide medical necessity justification for specialty enteral products by third party payers, we have created template letters that provide background information for many Nestlé products. These letters are intended to be used as a template and customized by the physician for each patient.  The list of diagnoses contained in this letter is not all-inclusive.  It is ultimately the responsibility of the health care professional associated with this patient’s care to determine and document the appropriate diagnosis for the patient’s condition.  Nestle Health Science does not guarantee that the use of any information provided in this letter will result in coverage or payment by any third-party payer. Sections of each letter have been left unprotected so that the author of the letter may include patient specific information.

Template Letter for Medical Necessity Alfamino®

Template Letter for Medical Necessity Boost®

Template Letter for Medical Necessity Boost® Kid Essentials™

Template Letter for Medical Necessity Boost® Kid Essentials™ 1.5

Template Letter for Medical Necessity Boost® Kids Essentials™ 1.5 Fiber

Template Letter for Medical Necessity Compleat®

Template Letter for Medical Necessity Compleat® Pediatric

Template Letter for Medical Necessity Compleat® Pediatric Reduced Calorie

Template Letter for Medical Necessity Diabetisource® AC

Template Letter for Medical Necessity IMPACT®

Template Letter for Medical Necessity IMPACT AR®

Template Letter for Medical Necessity IMPACT® PEPTIDE 1.5

Template Letter for Medical Necessity Glytrol®

Template Letter for Medical Necessity Novasource® Renal

Template Letter for Medical Necessity Peptamen®

Template Letter for Medical Necessity Peptamen® 1.5

Template Letter for Medical Necessity Peptamen AF®

Template Letter for Medical Necessity Peptamen Junior®

Template Letter for Medical Necessity Peptamen® with Prebio1™

Template Letter for Medical Necessity Peptamen® with Prebio1™

Template Letter for Medical Necessity Peptamen Junior® 1.5

Template Letter for Medical Necessity Peptamen Junior® Fiber

Template Letter for Medical Necessity Peptamen Junior® with Prebio1™

Template Letter for Medical Necessity Resource® ThickenUp® Clear

Template Letter for Medical Necessity Tolerex®

Template Letter for Medical Necessity Vivonex® TEN

Template Letter for Medical Necessity Vivonex® RTF

Template Letter for Medical Necessity Vivonex® Plus

Template Letter for Medical Necessity Vivonex® Pediatric