Included with this letter is the Statement of Necessity that is needed for your patients to get diabetic shoes.

Per Medicare, we also need the Chart Notes (progress notes) from the last visit with your patient. Please ensure the notes include the following three requirements:

• 1. A formal diabetes diagnosis.
• 2. Documented evidence of a foot exam.
• 3. The specific prescription sentence listed below:

Please fax the Statement of Necessity and Exam Notes to: (408) 376-0498.

Thank you,

Walk Rite for Life!
Certified Pedorthists (CPed)