Evaluation and Justification Form

Raz Mobile Shower Commode Chair (MSCC) Medical Justification Resources

The Raz Mobile Shower Commode Chair (MSCC) Justification Resources help clinicians justify the funding of the Raz model and configuration selected for the client. The Medical Justification Checklist can be submitted “as is” in states that allow a checklist format. For the creation of Letters of Medical Necessity (LMN), paragraph-form justification are available for all chairs and accessories.

Below is a list of all of our models with links to their respective forms. Please select the appropriate model.

Raz-AP (Attendant Propel):
Client / Home Environment Evaluation and Checklist
LMN Paragraphs

Raz-SP (Self Propel):
Client / Home Environment Evaluation and Checklist
LMN Paragraphs

Raz-AT (Attendant Tilt):
Client / Home Environment Evaluation and Checklist
LMN Paragraphs

Raz-CAT (Compact Attendant Tilt):
Client / Home Environment Evaluation and Checklist
LMN Paragraphs

Raz-ART (Attendant Rotational Tilt):
Client / Home Environment Evaluation and Checklist
LMN Paragraphs

Züm-AP (Attendant Propel):
Client / Home Environment Evaluation and Checklist
LMN Paragraphs

Züm-SP (Self Propel):
Client / Home Environment Evaluation and Checklist
LMN Paragraphs

Raz-AP600 (Attendant Propel – Heavy Duty):
Client / Home Environment Evaluation and Checklist
LMN Paragraphs

Raz-SP600 (Self Propel – Heavy Duty):
Client / Home Environment Evaluation and Checklist
LMN Paragraphs

Raz-AT600 (Attendant Tilt – Heavy Duty):
Client / Home Environment Evaluation and Checklist
LMN Paragraphs