SPECIMEN · synthetic patient · illustrative format — not a determination for a real person
ClinicalSwipe
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Letter of Medical Necessity
LMN-SPEC-0001 · rev A
Date of determination: August 27, 2026Valid through: August 27, 2027Review outcome: Approved

Letter of Medical Necessity

Re: Jordan A. Rivera (specimen) · DOB 04/xx/1979 · Member ID ••••4417
To: Plan Administrator / HSA·FSA Custodian

I am a licensed physician and have evaluated the above patient. This letter certifies the medical necessity of a specific therapeutic program to treat a diagnosed condition. It is not a statement about general health, fitness, or wellness.

The patient is under care for sarcopenia (skeletal-muscle loss), ICD-10 M62.84, arising as a recognized consequence of GLP-1 receptor-agonist pharmacotherapy prescribed for obesity (E66.9). In published trials of these agents, a substantial fraction of total weight lost — commonly 25–40% — is lean tissue rather than fat, which accelerates skeletal frailty, suppresses resting metabolic rate, and predisposes to functional decline.

Progressive resistance training, coupled with adequate dietary protein, is the recognized non-pharmacologic countermeasure to pharmacologically-induced lean-mass loss. It is prescribed here as treatment of the patient's diagnosed sarcopenia — to preserve and restore appendicular lean mass and physical function during medical weight loss — 2–3 supervised sessions per week, progressive overload, for 6 months with reassessment at 12 weeks. I certify that this program reflects my independent professional medical judgment and would not be recommended in the absence of the diagnosed condition. Had the clinical criteria not been met, this request would have been declined at the same review fee.

[Attesting Physician], DO
Licensed physician · NPI verified against CMS NPPES on issuance
Licensed in the patient's state of residence at time of review
signed
August 27, 2026
🔒 Cryptographically anchored · tamper-evident
sha256: 9ceeb91d1cb749cb9313dddf8756c062a0d396516204373e085579247be21800
This determination is hash-anchored and Bitcoin-countersigned. Anyone can confirm it was issued, unaltered, at hashcare.com/verify — no login, no PHI.
How a letter is issued: a member completes an honest intake → an AI drafts the determination → an independent, NPI-verified, specialty-matched physician reviews it and approves or declines under their own credential, at the same flat fee either way → the signed letter is hash-anchored. An unsigned AI output is treated as a liability, not a clinical output. This is a specimen — a synthetic patient, illustrative format, not a real determination; on a real letter the reviewing physician's name and NPI populate the signature block and the hash resolves to a live anchor. Educational; not legal, tax, or medical advice. HSA/FSA eligibility remains subject to plan rules and IRS §213(d).