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following sample letters in MS Word:
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Sample Letter for Tube-fed Consumer
___Date___
To Whom It May Concern:
My patient, _________patient name______, requires specialized nutrition support to sustain ____his/her___ life. ___He/She___ has an enteral feeding tube placed in ___his/her__ abdomen and sustains ___his/herself___ by pumping a nutritional formula through this tube.
** If you will need to pump formula during the flight add: Because of ____his/her___ medical condition, ____he/she___ will need to infuse formula through ____his/her___ tube during the flight.
___He/She___ may be traveling with any combination of the supplies listed below:
• Feeding pump
• Canned formula
• Syringes
• Tubing and feeding bags, etc.
These supplies are medically necessary and could be difficult to obtain while ___he/she___ is away from ___his/her___ local physicians and suppliers; therefore I request that ___he/she__ be allowed to carry them with ___him/her___.
Please do not hesitate to contact me at (_____) _____ – ________ if you have any questions or need additional information.
Very sincerely,
_____physician’s name________
_____physician’s title_________
Sample Letter for IV-fed Consumer
___Date___
To Whom It May Concern:
My patient, _________patient name______, requires specialized nutrition support to sustain ____his/her___ life. ___He/She___ has a central venous catheter placed in ___his/her___ ___chest/neck/arm/leg___ and sustains ___his/herself___ by pumping a nutritional formula through this catheter.
** If you will need to infuse during the flight add: Because of ____his/her___ medical condition, ____he/she___ will need to infuse fluids through ____his/her___ catheter during the flight.
___He/She___ may be traveling with any combination of the supplies listed below:
• Feeding pump
• Intravenous (IV) formula
• Syringes
• Vials that contain vitamins and other additives/flushes
• Tubing, connectors, dressings, etc.
These supplies are medically necessary and will be difficult to obtain while ___he/she___ is away from ___his/her___ local physicians and suppliers; therefore I request that ___he/she__ be allowed to carry them with ___him/her___..
Please do not hesitate to contact me at (_____) _____ – ________ if you have any questions or need additional information.
Very sincerely,
_____physician’s name________
_____physician’s title_________