RE: Aschdon Birkle
DOB: 5-7-99

To Whom It May Concern:

Aschdon is a young patient of ours with a diagnosis of Spinal Muscular Atrophy (SMA). He has recently acquired and initiated use of an In-Exsufflator machine and a Bi-Pap machine. Both of these pieces of equipment are extremely important from both treatment and prophylaxis standpoints with regards to his fragile respiratory condition.

He will required frequent titration of his settings as well as frequency and daily duration of use with both of these machines based on his current health status. In order to regulate these changes, we need to have effective monitoring parameters.

This is a letter of medical necessity for a Pulse Oximetry device. He requires the use of this piece of equipment for monitoring purposes. We need to monitor his oxygenation status in order to make changes in his therapy. We also need to have this information for evaluation of his respiratory status to help determine when physician visits/hospitalizations are necessary. We are unable to effectively utilize the Bi-Pap without a pulse ox.

Aschdon needs a pulse oximeter capable of printing readouts for the health care team to titrate his settings. An alarm for low sats is also necessary. He needs the probe for a finger or toe, as it will be on continuously during day and night sleep periods, as well as during acute illnesses. Portability is also key as he will need this during any necessary travel when ill.

Please feel free to call with any questions you may have.

Sincerely

Adam Craner, MS, FNP-C
Pediatric Neuromuscular Neurology

This is a letter of medical necessity for a feeding pump, provided by his doctor.

December 5, 2002

Dear Sir,

It has been my pleasure to provide care for Aschdon Birkle over this last year. Aschdon is a 3-1/2 year old who suffers from spinal muscular atrophy type 2 which has been explained in the history and physical. This is a progressive muscular disorder. Individuals who suffer from this disease do have difficulty ultimately with breathing problems as well as with feeding problems. The latter problem had been addressed in Salt Lake City where he did receive a G-tube placement so that he could receive eternal feeds in the form of Vivonex 32 ounces q hs. Since these feeds have been initiated, Aschdon has improved overall in terms of his strength and in his health; however, he continues to have difficulty feeding during the day. Currently Aschdon could benefit from a smaller more portable feeding pump that could be used both during the night as well as during the day. This would assist mother in administering these feeds as well as assist Aschdon in terms of his over all health and well-being.

If you have any questions, please feel free to call me at the Wheatland Medical Clinic,(***) *** ****

Sincerely,

Jeremy M Katzmann, MD., F.A.B.F.P