Letter of Medical Necessity Template

You may need to document a patient’s medical necessity for treatment to get insurance coverage.


It’s easy to complete the letter

Just fill in the fields, and we'll generate a letter you can use instantly. You can preview it, then create a PDF to submit when enrolling your patient in NUPLAZIDconnect. You can also download the Letter of Medical Necessity template. (All information required unless marked "optional")

Patient Gender
Patient has been diagnosed with Parkinson’s disease (PD)
In order to continue, you must correct the errors above.
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For healthcare professionals