This Education in Motion resource is also available as a printable PDF.
The power assist sample letter of medical necessity (LMN) serves as a guide to highlight the clinical benefits of power assist. When using a sample LMN, customize the content to fit the specific needs of the individual rider. It is crucial to provide specific examples of the rider's daily routine, the difficulties they have with mobility, and how a power assist system will promote maximal independence with Mobility-Related Activities of Daily Living (MRADLs). The sample letter aims to streamline the approval process, potentially reducing lead times to get the equipment to the rider sooner to maximize outcomes. Always ensure that the information included is relevant and specific to the individual request. Only use what is needed and be sure to customize the content based on the request. Click the download button above to view the sample LMN.
Published: 7/29/2026
Let it drive you!
Small, light, and packed with power
The Empulse M90 adds sleek, stylish power to your manual wheelchair without weighing you down.
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