A Certificate of Medical Necessity is a document required by Centers for Medicare and Medicaid Services to substantiate the medical necessity of an item (e.g., a durable medical equipment) or service furnished to a Medicare beneficiary. Medical necessity is a legal doctrine, related to activities which may be justified as reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care. By statute, Medicare may only pay for items and services that are "reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member", unless there is another statutory authorization for payment. - adapted from wikipedia.

Attributes
Answer	assessmentResponse	Pointer to a set of questions and answers. The FHIM reuses a structure built for this purpose from the Assessment domain. This association to the assessment response/question corresponds to the following fields in the NCPDP Telecommunication standard: 378-4B, Question Number/Letter; 379-4D, Question Percent Response; 379-4D, Question Date Response; 381-4H, Question Dollar Amount Response; 382-4J, Question Numeric Response; 383-4K, Question Alphanumeric Response.
«CS» Code	category	"Unique identifier for the data being submitted." - NCPDP Telecommunication (Field 369-2Q, Data Dictionary 201104). Possible values include: Hospital Beds; Support Surfaces; Motorized Wheel Chair; Manual Wheelchair; Continuous Positive Airway Pressure (CPAP); Lymphedema Pumps; Osteogenesis Stimulator; Transcutaneous Electrical Nerve Stimulator TENS); Seat Lift Mechanisms; Power Operated Vehicles (POV); Immunosuppressive Drugs; Infusion Pump; Parenteral Nutrition; Enteral Nutrition; Oxygen.
«TS» PointInTime	dateBegin	"The beginning date of need." - NCPDP Telecommunication (Field 374-2V, Data Dictionary 201104).
«TS» PointInTime	dateRevisedOrRecertified	"The effective date of the revision or re-certification provided by the certifying physician." - NCPDP Telecommunication (Field 375-2W, Data Dictionary 201104).
«TS» PointInTime	dateSigned	"The date the form was completed and signed by the ordering physician." - NCPDP Telecommunication (Field 372-2T, Data Dictionary 201104).
«PQ» TimeQuantity	lengthOfNeed	"Length of time the physician expects the patient to require use of the ordered item." - NCPDP Telecommunication (Field 370-2R, Data Dictionary 201104). Note that the NCPDP Telecommunication structure uses a separate "qualifier" field (371-2S) to provide the units of measure for the time quantity represented in 370-2R. Possible values include: Hours; Days; Weeks; Months; Years; Lifetime; Not Specified. Note that each of these units, except for "Lifetime" are handled in the TimeQuantity datatype.
String	narrative	"Free text message" - NCPDP Telecommunication (Field 376-2X, Data Dictionary 201104).
Integer	questionCount	"Count of Question Number/Letter occurrences." - NCPDP Telecommunication (Field 377-2Z, Data Dictionary 201104). Note that this is modeled as a derived property as it may potentially be calculated based on the number of Assessment Instrument Response instances.
«CS» Code	requestStatus	"Code identifying type of request." - NCPDP Telecommunication (Field 373-2U, Data Dictionary 201104). Possible values include: Initial; Revision; Recertification; Not Specified.

 assessmentResponse

Public Answer assessmentResponse

Pointer to a set of questions and answers. The FHIM reuses a structure built for this purpose from the Assessment domain. This association to the assessment response/question corresponds to the following fields in the NCPDP Telecommunication standard: 378-4B, Question Number/Letter; 379-4D, Question Percent Response; 379-4D, Question Date Response; 381-4H, Question Dollar Amount Response; 382-4J, Question Numeric Response; 383-4K, Question Alphanumeric Response.

Constraints:

Properties:

Aggregation	None
Alias
Association	certificateOfMedicalNecessity_assessmentResponse
Association End
Class	CertificateOfMedicalNecessity
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	*
Name	assessmentResponse
Name Expression
Namespace	CertificateOfMedicalNecessity
Opposite
Owner	CertificateOfMedicalNecessity
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CertificateOfMedicalNecessity::assessmentResponse
Stereotype
Template Parameter
Type	Answer
Upper	*
Upper Value	(*)
Visibility	Public

 category

Public «CS» Code category

"Unique identifier for the data being submitted." - NCPDP Telecommunication (Field 369-2Q, Data Dictionary 201104). Possible values include: Hospital Beds; Support Surfaces; Motorized Wheel Chair; Manual Wheelchair; Continuous Positive Airway Pressure (CPAP); Lymphedema Pumps; Osteogenesis Stimulator; Transcutaneous Electrical Nerve Stimulator TENS); Seat Lift Mechanisms; Power Operated Vehicles (POV); Immunosuppressive Drugs; Infusion Pump; Parenteral Nutrition; Enteral Nutrition; Oxygen.

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	CertificateOfMedicalNecessity
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	1
Lower Value	(1)
Multiplicity	1
Name	category
Name Expression
Namespace	CertificateOfMedicalNecessity
Opposite
Owner	CertificateOfMedicalNecessity
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CertificateOfMedicalNecessity::category
Stereotype
Template Parameter
Type	«CS» Code
Upper	1
Upper Value	(1)
Visibility	Public

 dateBegin

Public «TS» PointInTime dateBegin

"The beginning date of need." - NCPDP Telecommunication (Field 374-2V, Data Dictionary 201104).

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	CertificateOfMedicalNecessity
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	1
Lower Value	(1)
Multiplicity	1
Name	dateBegin
Name Expression
Namespace	CertificateOfMedicalNecessity
Opposite
Owner	CertificateOfMedicalNecessity
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CertificateOfMedicalNecessity::dateBegin
Stereotype
Template Parameter
Type	«TS» PointInTime
Upper	1
Upper Value	(1)
Visibility	Public

 dateRevisedOrRecertified

Public «TS» PointInTime dateRevisedOrRecertified

"The effective date of the revision or re-certification provided by the certifying physician." - NCPDP Telecommunication (Field 375-2W, Data Dictionary 201104).

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	CertificateOfMedicalNecessity
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	dateRevisedOrRecertified
Name Expression
Namespace	CertificateOfMedicalNecessity
Opposite
Owner	CertificateOfMedicalNecessity
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CertificateOfMedicalNecessity::dateRevisedOrRecertified
Stereotype
Template Parameter
Type	«TS» PointInTime
Upper	1
Upper Value	(1)
Visibility	Public

 dateSigned

Public «TS» PointInTime dateSigned

"The date the form was completed and signed by the ordering physician." - NCPDP Telecommunication (Field 372-2T, Data Dictionary 201104).

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	CertificateOfMedicalNecessity
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	1
Lower Value	(1)
Multiplicity	1
Name	dateSigned
Name Expression
Namespace	CertificateOfMedicalNecessity
Opposite
Owner	CertificateOfMedicalNecessity
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CertificateOfMedicalNecessity::dateSigned
Stereotype
Template Parameter
Type	«TS» PointInTime
Upper	1
Upper Value	(1)
Visibility	Public

 lengthOfNeed

Public «PQ» TimeQuantity lengthOfNeed

"Length of time the physician expects the patient to require use of the ordered item." - NCPDP Telecommunication (Field 370-2R, Data Dictionary 201104). Note that the NCPDP Telecommunication structure uses a separate "qualifier" field (371-2S) to provide the units of measure for the time quantity represented in 370-2R. Possible values include: Hours; Days; Weeks; Months; Years; Lifetime; Not Specified. Note that each of these units, except for "Lifetime" are handled in the TimeQuantity datatype.

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	CertificateOfMedicalNecessity
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	0
Lower Value	(0)
Multiplicity	0..1
Name	lengthOfNeed
Name Expression
Namespace	CertificateOfMedicalNecessity
Opposite
Owner	CertificateOfMedicalNecessity
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CertificateOfMedicalNecessity::lengthOfNeed
Stereotype
Template Parameter
Type	«PQ» TimeQuantity
Upper	1
Upper Value	(1)
Visibility	Public

 narrative

Public String narrative

"Free text message" - NCPDP Telecommunication (Field 376-2X, Data Dictionary 201104).

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	CertificateOfMedicalNecessity
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	1
Lower Value	(1)
Multiplicity	1
Name	narrative
Name Expression
Namespace	CertificateOfMedicalNecessity
Opposite
Owner	CertificateOfMedicalNecessity
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CertificateOfMedicalNecessity::narrative
Stereotype
Template Parameter
Type	String
Upper	1
Upper Value	(1)
Visibility	Public

 questionCount

Public Integer questionCount

"Count of Question Number/Letter occurrences." - NCPDP Telecommunication (Field 377-2Z, Data Dictionary 201104). Note that this is modeled as a derived property as it may potentially be calculated based on the number of Assessment Instrument Response instances.

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	CertificateOfMedicalNecessity
Datatype
Default
Default Value
Is Composite	false
Is Derived	true
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	1
Lower Value	(1)
Multiplicity	1
Name	questionCount
Name Expression
Namespace	CertificateOfMedicalNecessity
Opposite
Owner	CertificateOfMedicalNecessity
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CertificateOfMedicalNecessity::questionCount
Stereotype
Template Parameter
Type	Integer
Upper	1
Upper Value	(1)
Visibility	Public

 requestStatus

Public «CS» Code requestStatus

"Code identifying type of request." - NCPDP Telecommunication (Field 373-2U, Data Dictionary 201104). Possible values include: Initial; Revision; Recertification; Not Specified.

Constraints:

Properties:

Aggregation	None
Alias
Association
Association End
Class	CertificateOfMedicalNecessity
Datatype
Default
Default Value
Is Composite	false
Is Derived	false
Is Derived Union	false
Is Leaf	false
Is Ordered	false
Is Read Only	false
Is Static	false
Is Unique	true
Keywords
Lower	1
Lower Value	(1)
Multiplicity	1
Name	requestStatus
Name Expression
Namespace	CertificateOfMedicalNecessity
Opposite
Owner	CertificateOfMedicalNecessity
Owning Association
Owning Template Parameter
Qualified Name	FHIM::EnrollEligCOB::CertificateOfMedicalNecessity::requestStatus
Stereotype
Template Parameter
Type	«CS» Code
Upper	1
Upper Value	(1)
Visibility	Public