Medical History: Briefly/ succinctly stated including diagnosis with onset date, comorbidities, and surgeries.
Current Medical Status and Functional Status: Explain the beneficiary's condition with emphasis on functional ability and impairments. Make the reader “see” this child. Include all durable medical equipment this child is already using.
Itemized Description of Medical Necessity for Special Tomato Soft Touch Booster Car Seat (ALL Special Tomato Soft Touch Booster Car Seat Features are included and are not limited to example of the product being ordered).
Special Tomato Soft Touch Booster Car Seat has a contoured back that supports the natural curvature of the spine. Lateral trunk supports and head support (occipital ridge) are molded into the seat itself and help the user maintain a well aligned upright position. The contoured seat is designed to allow the ischial tuberosities (ITs) commonly called “sit bones” to comfortably sink into the seat thereby creating the stable base required for the foundation of the seated posture. The contoured seat also includes a 15 degree ramped angle with built in abductor. Both features ensure a well aligned hip position.
*Adjustable 5-Point Trunk Positioning Harness can be adjusted to fit the user as she/he grows. Shoulder straps discourage rounding of the spine by keeping shoulders back in the seat. Bottom pull straps (separate/ independent of Pelvic Positioning Harness) and center side release clasp ensure the ability of the harness to maintain an upright midline posture of the trunk.
*Adjustable 3-Point Pelvis Positioning Harness The straps across hips along with the crotch strap can be tightened to prevent sliding forward in the seat. Adjustable strapping can be loosened when less support is required.
*Please Note: Harnesses are used for positioning support only. It is the vehicles seat belt (shoulder strap and lap belt) that acts as the child’s safety restraint.
Attachment Straps (2) come standard with the Special Tomato Soft Touch Booster Car Seat. The attachment straps can be used to secure the Booster Car Seat to any stable standard chair allowing its use in many environments and eliminating the need for multiple pieces of costly equipment. The Large Booster Seat weighs only 15 lbs. compared to the typical 40-50 lbs. of a similar booster seat, making it truly portable.
*Please Note: The Special Tomato Soft Touch Booster Car Seat is compatible with the bases below for greater versatility in use.
Floor Sitter Base- Tilt-in-space positioning allows for fully upright sitting or sitting tilted back as far as 25 degrees and anywhere in between. This allows the user to engage postural muscles to varying degrees as tolerated and as activity dictates. With the Floor Sitter Wedge Base, the user can be positioned sitting on the floor where peers and siblings typically play.
Stationary Base and Mobile Base- The Stationary Base allows children to be close to the floor without caregivers having to transfer them all the way down to the floor. The Stationary Base is equipped with furniture glides to protect floors. The Mobile Base is the same as the Stationary Base, with the addition of wheels to allow the child to be moved room to room or to different parts of the classroom without picking up the child. The Sitter on a Stationary or Mobile Base is perfect for circle time at school, playing with friends and siblings at home or “chilling out” with the rest of the family at home.
It may also be helpful to include a picture of the Special Tomato Soft-Touch Booster Car Seat.
Thank you for taking the time to consider this request for Tariq. Please contact me if you have any questions or if you need further clarification. I can be reached at 000-000-0000.
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