Date
Jane Doe
Case manager
Insurance Company
City, State, Zip Code
Phone Number
Fax Number
Re: Tina Smith
Insurance I.D. #
DOB: 01/01/88
To Whom It May Concern:
We are writing this letter to summarize our treatment recommendations for Tina Smith.
We have been following Jane in our eating disorder program since April 12, 200X. During these past two years, Tina has had six hospitalizations for medical complications of her malnutrition including profound bradycardia, hypothermia, and orthostasis.
Her hospital admissions are listed below:
Admission date – Discharge Date Profound Bradycardia
Admission date -Discharge Date Profound Bradycardia and Hypothermia
Admission date – Discharge Date Bradycardia and Orthostasis
Admission date – Discharge Date Bradycardia
Admission date – Discharge Date Orthostasis
Admission date – Discharge Date Bradycardia
In all, Tina has spent 11 days of the past two years in the hospital due to cardiac complications of her malnutrition.
Tina’s Malnutrition is damaging more than her heart. The following medical issues have complicated her course:
- Secondary amenorrhea since August 200X. This prolonged amenorrhea has the potential to cause irreversible bone damage leading to osteoporosis in her early adult life.
- As above, significant risk for Osteopenia. Bone density results are pending examination.
- Essential fatty acid deficiency, which can impact all organs, most especially her neurocognitive function.
- Hypophosphatemia
- Constipation, delayed gastric transit, and abdominal pain
- Leucopoenia
- Hypoalbuminemia
Despite receiving intensive outpatient medical, nutritional, and psychiatric treatment, Tina’s medical condition has continued to deteriorate. She has had consistent weight loss since January 200X, and is currently 83 percent of her estimated minimal ideal body weight (the weight where the nutritionist estimates she will regain her menses. Her white blood cell count and serum protein and albumin levels have been steadily decreasing as well, because of her extraordinarily poor nutritional intake.
Due to Tina’s poor nutritional progress and continued medical complications despite receiving intensive outpatient treatment for Anorexia Nervosa, it is our strong recommendation that she needs more intensive psychiatric and nutritional treatment. The type of treatment that Jane needs is offered only in a residential treatment program specializing in eating disorders. We recommend a minimum of a sixty- to ninety-day stay in a program that offers a tiered approach, with intensive residential and transitional components that focus on the care of adolescents and young adults with eating disorders. Tina requires daily psychiatric, psychological, and nutritional treatment by therapists well trained in the Treatment of her disease. She will be best served by a program that is age appropriate for her, and not a program for much older adults. In such a tiered program, Jane could get the residential treatment that she so desperately needs, and then show that she can maintain any progress in a transitional setting. We do NOT recommend treatment in a non-eating disorder specific behavioral treatment center, as Tina has a severe case of anorexia and deserves subspecialty-level care. Some examples of such programs would include (name a few programs).
Anorexia Nervosa is a deadly disease with a 10-15 percent mortality rate and 15-25 percent developing a severe lifelong course. We believe that without the intensive treatment of a residential program, Tina’s malnutrition, and the medical complication that is causes, will continue to worsen, and Tina will be at a significant risk of developing lifelong anorexia nervosa or dying of her disease. We understand that, in the past, your reviewers had denied this level of care.
This is the only appropriate and medically responsible care plan that we can recommend for Tina. We truly believe that to offer her less is medically negligent, and trust that you will share our grave concern for Tina’s need and approve such care to assist in her emotional and physical recovery. Thank you for your thorough consideration of this matter. Please feel free to contact us with any concerns regarding Tina’s care.
Sincerely,
NAME OF DOCTOR
