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(2) if the recipient is under 21 years of age, documentation by the person under (1) of this subsection that the item or service is necessary to treat, correct, or ameliorate a defect, condition, or physical or mental illness; the documentation may replace the certificate of medical necessity required under (1) of this subsection;

(3) for requests under (b)(2) and (4) of this section relating to a request for incontinence supplies, the certificate of medical necessity required under (1) of this subsection, on a form provided by the department, that includes the

(A) diagnosis, including the diagnosis code from the International Classification of Disease, adopted by reference in 7 AAC 160.900, that is related to the cause or is causing the incontinence of the bladder, bowels, or both;

(B) diagnosis, including the diagnosis code from the International Classification of Disease, adopted by reference in 7 AAC 160.900, of the type of incontinence;

(C) for recipients at least three years of age and under 10 years of age, documentation that the recipient has not responded to, would not benefit from, or has failed bowel or bladder training;

(D) prognosis for controlling incontinence;

(E) name of each item to be dispensed;

(F) frequency of incontinence;

(G) duration of need;

(H) diuretic or other medications that increase output;

(I) products currently being used;

(J) skin integrity, including vulnerability to skin breakdown;

(K) measurements of product sizes;

(L) quantity of each item medically necessary;

(M) known allergies to product materials; and

(N) description of ability to manage incontinence independently or with assistance. (d) In addition to the requirements of (c) of this section, a service authorization request for the following items must, if available, include the manufacturer information, item description or number, global trade item number (GTIN), suggested list price, and serial number:

(1) items that are identified as miscellaneous in the Healthcare Common Procedure Coding System (HCPCS), adopted by reference in 7 AAC 160.900;