PATIENT :Alyazia Alshamsi

JUSTIFICATION WITH ASSESMENT ; Alyazia is a Patient with known case of Spina Bifida with
hydrocephalus on Ventriculeritoneal shunt.She is also having recurrent Seizures.She was given a
custom-made Rigid Wheel Chair From Al Ain Hospital which she used for 08 Months and develop
sever Health issues with it,Her wheel chair is over sized and it creates Abrasion on underneath of
knees and As she is Spina Bifida Patient too her Back cushion material is not accordingly to
accommodate her back properly,she is having sudden attack of seizers so, her Wheel breaks are also
not that good to help her out in emerginses .
Kindly Approve for her the Adaptive Folding wheel Chair with Integrated leg Rest,With Highly
stable Frame Which Will help her to overcome with her Daily Health Issues lessen.
 over night and also dynamic kindly approve the above mention HCPCS for patient Limbs Correction
and stability.
if you have any question and need further clarification,please don’t hesitate to contact me .