100 Chiropractic, Physical Therapy, Acupuncture, Medicare & HIPAA Forms, Logs & Templates

NEW PATIENT:

• New Patient Health History Questionnaire
• Patient Update Questionnaire
• Review of Systems
• Authorization for Assignment & Release
• Lien/Letter of Protection
• General Office Policy

FINANCIAL & ADMINISTRATION:

• Patient Financial Policy
• Financial Hardship Form
• Insurance Non-Covered Services Form
• Health Savings Account Statements
• Consent to Treat Minor
• Insurance Payment Goes to Patient
• Insurance Verification Form
• Cell Phone Use Policy
• Attorney Records Request Letter

EXAMS & TREATMENT PLANS:

• New Patient Examination
• Chiropractic Treatment Plan
• Chiropractic Re-examination
• ASH Re-Exam (MNR-Tier 3)
• Cash Wellness
• Re-Exam
• Personal Injury Initial Report
• Personal Injury Final Report
• Radiology Report

TELEHEALTH:

• Revised HIPAA Notice
• Acknowledgement of HIPAA Notice
• General Office Policy
• Patient Financial Policy
• TeleHealth Non-Covered Services Form
• HSA Statement with TeleHealth Codes
• Consent to Treat Minor Form
• TeleHealth Insurance Verification Form
• TeleHealth Patient Acknowledgment Form
• New Patient Phone Call Intake Form
• ABN for Non Covered TeleHealth Services
• Medicare Part B Notice for Non Covered Services
• Medicare Advantage Plan for TeleHealth Services
• Patient COVID-19 Screening Questionnaire
• TeleHealth Coding Cheat Sheet
• Sample TeleHealth Informed Consent
• TeleHealth Insurance Tracking Spreadsheet
• Sample TeleHealth SOAP Note
• Sample TeleHealth PI SOAP Note
• Sample TeleHealth Nutrition SOAP Note
• Sample TeleHealth 97110 SOAP Note
• Sample TeleHealth 97112 SOAP Note
• Sample TeleHealth 97535 SOAP Note
• Sample TeleHealth 97750 SOAP Note
• Sample TeleHealth TENS SOAP Note
• Sample TeleHealth LSO Brace Note
• Sample TeleHealth Home Cervical Traction Note

LETTERS OF MEDICAL NECESSITY:

• LOMN for ADLs
• LOMN for Laser Therapy
• LOMN for Taping
• LOMN for Spinal Decompression Therapy
• LOMN for Vibration Therapy
• LOMN for Varidesk/Stand-up Desk
• LOMN for Orthotics
• LOMN for Support Pillow
• LOMN for Back Braces
• LOMN for TENS with Order Form
• LOMN for Cervical Collar
• LOMN for Additional Chiropractic Visits

APPEALS:

• Re-exam & Spinal CMT on Same Day
• Spinal CMT & 97140 on Same Day
• Spinal CMT & 97124 in Same Region
• Treatment Summary Following Audit

PHYSICAL THERAPY:

• Physical Therapy Order/Referral
• Physical Therapy Plan of Care
• Physical Therapy SOAP Note
• Physical Therapy Re-evaluation

ACUPUNCTURE:

• Acupuncture Treatment Plan
• Acupuncture SOAP Note
• Acupuncture Re-examination
• Acupuncture Financial Disclosure Form

MEDICARE:

• Initial Chiropractic Visit
• Subsequent Chiropractic Visit
• Chiropractic Re-examination
• ABN for Chiropractic Maintenance Care
• ABN for Non-Covered Services
• ABN for Non-Par/Non-Assignment
• Medicare Notice for Non-Payable Services
• Medicare Advantage Plan Patient Form

SOAP NOTES:

• SOAP Note #1 (Fill In)
• SOAP Note #2 (98941, 97110, 97140)
• SOAP Note #3 (98941, 97110, 97012)
• SOAP Note #4 (98940, 97110, 97112)
• SOAP Note #5 (98941, 97530, 97112)
• SOAP Note #6 (98941, 97110, 97140)
• SOAP Note #7 (Personal Injury)
• SOAP Note #8 (Massage)
• SOAP Note #9 (Wellness No Symptoms)
• SOAP Note #10 (Wellness Symptoms)

PLUS 23 HIPAA FORMS