Category: Sample Resource Request Letters

Educational Placement Template Letter

This template letter may be useful in obtaining the educational placement or services you need for your child. Child Neurologist Address October 1, 2007 Preschool Coordinator Public School System Dear Ms. XXXXXX I am a pediatric epileptologist and care for __________.  I am writing to you concerning  _________  preschool placement within the ____________ County public […]

Adaptive Stroller Request Template Letter

This template letter for an adaptive stroller and adaptive car seat for your child may be useful if you are pursuing payment of these items by your insurance carrier. Aetna paid for the stroller but not the car seat. Aetna Appeals Resolution Team Re:  Denial #_________ Patient:  _________ DOB:  _________ To Whom it May Concern: […]

FAPE Pre-school Letter Template

At times, as a parent advocate for a child with intractable epilepsy, we must become warriors.  Your school age child is entitled to a Free and Appropriate Education (FAPE) beginning at age 3 years old in most states. Below is an example of a letter written to advocate for a child to be placed in […]

Canadian Dravet Syndrome Template Letter

Below is a letter on behalf of Canadian families who are seeking payment of Dravet syndrome therapies.  This letter was distributed to the National Health Plan on the patient’s behalf. Danielle Allan, PharmD Founder Intractable Childhood Epilepsy Alliance York, PA 17401 Date Canadian xxxxxx Xxxxxxxx Xxxxxzxxz zzzzzz

Request for Nursing Services

To all ICE advocates:  This letter was written by a parent of a child with Dravet syndrome who appealed to the Ohio state Medicaid department for nursing services to care for her child.  Each state has a different policy and plan for developmentally disabled children and their care, dependent on level of need.  Please look […]

Orphan Drug Request Template Letter

Dear Parent: This is the template I have given to many parents who have advocated for payment of stiripentol, clobazam or Epistatus by private insurance or Medicaid. My first job out of residency was as Clinical Formulary Manager for a Health Maintenance Organization (HMO).  In this role, I decided if exceptions should be made for […]