Customizable Forms Packet
Customizable Forms: 100 Chiropractic, Physical Therapy, Acupuncture, Medicare & HIPAA Forms, Logs & Template
- Topic Areas:
- Customizable Forms, Letters & Templates | Acupuncture | Audit Prevention/Protection | Billing Department | Compliance | Compliant Documentation | Documentation | Financial Management | Financial Policies | Financial Tools | HIPAA | Insurance Billing | Insurance Denial Appeals | Medicare | Medicare ABN Form | Medicare Compliance | Recordkeeping | SOAP Notes | Treatment Plan | Physical Therapy
- Categories:
- Acupuncture | Appeals | Business Strategies | Chiropractic Assistant (CA) | Chiropractic Documentation | Chiropractic Treatment Plans | Compliance | Documentation | Financial | Forms | HIPAA | Insurance Billing Compliance | Medical Necessity | Medicare | Patient Financial Management | ICD-10
Tags: Product
Description
These customizable forms allow you to simply fill in the blanks & within minutes your forms are ready to go!
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
- Acknowledgment 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 and More!
* All Forms are in Word Format
Handouts
| 1 - New Patient Health History (23.4 KB) | Available after Purchase | ||
| 10 - Non-Covered Services Form (21.8 KB) | Available after Purchase | ||
| 28 - SOAP Note #2 - 98941, 97110, 97140 (75.9 KB) | Available after Purchase | ||
| 27 - SOAP Note #1 - Fill in (35.8 KB) | Available after Purchase | ||
| 73 - Target Coding - Quick Guide - Extremity - 2024 (42.8 KB) | Available after Purchase | ||
| 72 - Target Coding - Quick Guide - Spine - 2025 (60.4 KB) | Available after Purchase | ||
| 74 - Target Coding - Quick Guide - Head, Ribs, SI, & Non-Neuro - 2024 (31.7 KB) | Available after Purchase | ||
| 75a - Target Coding - Quick Guide - Personal Injury - pg 1 - 2024 (46 KB) | Available after Purchase | ||
| 85 - Target Coding - ICD-10 Justification Sheets (321.9 KB) | Available after Purchase | ||
| 75b - Target Coding - Quick Guide - Personal Injury - pg 2 - 2024 (41.5 KB) | Available after Purchase | ||
| 83 - SOAP Note with Checklist - 98941, 98943, 97110, 97012 (31.3 KB) | Available after Purchase | ||
| 76 - Target Coding - Medicare Quick Guide - 2025 (57.2 KB) | Available after Purchase | ||
| 84 - Sample Patient Care Plan & Financial Agreement (140.5 KB) | Available after Purchase | ||
| 4 - Authorization & Assignment (15.5 KB) | Available after Purchase | ||
| 8 - Patient Financial Policy (20.9 KB) | Available after Purchase | ||
| 9 - Financial Hardship Form Update (17.8 KB) | Available after Purchase | ||
| 29 - SOAP Note #3 - 98941, 97110, 97012 (22.6 KB) | Available after Purchase | ||
| 31 - SOAP Note #5 - 98941, 97530, 97112 (23.2 KB) | Available after Purchase | ||
| 30 - SOAP Note #4 - 98940, 97110, 97112 (22.6 KB) | Available after Purchase | ||
| 32 - SOAP Note #6 - 98940, 97110, 97140 (24 KB) | Available after Purchase | ||
| 33 - SOAP Note #7 - PI - 98940, 97110, 97140 (23.3 KB) | Available after Purchase | ||
| 35 - SOAP Note #9 - Wellness no Symptoms (21.4 KB) | Available after Purchase | ||
| 34 - SOAP Note #8 - Massage - 97124 (22.2 KB) | Available after Purchase | ||
| 41 - LOMN for Vibration Therapy (21.1 KB) | Available after Purchase | ||
| 42 - LOMN for Varidesk - Stand-Up Desk (19.1 KB) | Available after Purchase | ||
| 43 - LOMN for Orthotics (19.3 KB) | Available after Purchase | ||
| 11 - HSA Statement without Codes (28.2 KB) | Available after Purchase | ||
| 5 - Lien - Letter of Protection (21.9 KB) | Available after Purchase | ||
| 13 - HSA Statement for Maintenance & Wellness (28.2 KB) | Available after Purchase | ||
| 12 - HSA Statement with Codes (28.2 KB) | Available after Purchase | ||
| 15 - Insurance Check Goes To Patient (19.2 KB) | Available after Purchase | ||
| 18 - Attorney Records Request (18 KB) | Available after Purchase | ||
| 3 - Review of Systems Form (33.1 KB) | Available after Purchase | ||
| 44 - LOMN for Support Pillow (18.9 KB) | Available after Purchase | ||
| 45 - LOMN for Back Braces (19.2 KB) | Available after Purchase | ||
| 19 - Examination Form (44 KB) | Available after Purchase | ||
| 7 - General Office Policy (17.6 KB) | Available after Purchase | ||
| 16 - Insurance Verification Form (25.3 KB) | Available after Purchase | ||
| 51 - Spinal CMT & 97124 on the Same Day (16.4 KB) | Available after Purchase | ||
| 21 - Chiropractic Re-examination (28.9 KB) | Available after Purchase | ||
| 14 - Consent to Treat Minor Form (20.9 KB) | Available after Purchase | ||
| 54 - Physical Therapy Plan of Care (33.6 KB) | Available after Purchase | ||
| 53 - Physical Therapy Referral & Order Form (19.5 KB) | Available after Purchase | ||
| 17 - Cell Phone Policy (15.7 KB) | Available after Purchase | ||
| 20 - Chiropractic Treatment Plan (28.9 KB) | Available after Purchase | ||
| 37 - LOMN for ADLs (18.2 KB) | Available after Purchase | ||
| 24 - PI Initial Report (40.5 KB) | Available after Purchase | ||
| 59 - Acupuncture Re-examination (26.9 KB) | Available after Purchase | ||
| 60 - Acupuncture & Medicare Financial Disclosure (15 KB) | Available after Purchase | ||
| 22 - ASH Re-Evaluation MNR - Tier 3 (29.3 KB) | Available after Purchase | ||
| 63 - Medicare Chiropractic Re-examination (30.5 KB) | Available after Purchase | ||
| 65 - ABN for Non-Covered Services - 01.31.2026 (30.8 KB) | Available after Purchase | ||
| 66 - ABN for Chiropractic Maintenance - 01.31.26 (30.8 KB) | Available after Purchase | ||
| 46 - LOMN for TENS (21.3 KB) | Available after Purchase | ||
| 64 - Medicare Notice for Non-Covered Services (20.2 KB) | Available after Purchase | ||
| 25 - PI Final Report (30.3 KB) | Available after Purchase | ||
| 23 - Cash Wellness Re-exam (23.2 KB) | Available after Purchase | ||
| 52 - Sample DC Treatment Summary (21.4 KB) | Available after Purchase | ||
| 68 - ABN for Dual Eligibility - 01.31.2026 (34.8 KB) | Available after Purchase | ||
| 26 - Radiology Report (22.2 KB) | Available after Purchase | ||
| 57 - Acupuncture Treatment Plan (27.6 KB) | Available after Purchase | ||
| 55 - Physical Therapy SOAP Note (36.4 KB) | Available after Purchase | ||
| 61 - Medicare Initial Chiropractic Visit (29.4 KB) | Available after Purchase | ||
| 69 - Blank ABN Form - 01.31.26 (25.6 KB) | Available after Purchase | ||
| 81 - Medicare Advantage Plan In-Network Non-Covered Services (22.7 KB) | Available after Purchase | ||
| 79 - Upper Extremity Index Score - Y (40.5 KB) | Available after Purchase | ||
| 80 - Lower Extremity Index Score - Y (26.7 KB) | Available after Purchase | ||
| 62 - Medicare Subsequent Visit (26.1 KB) | Available after Purchase | ||
| 73 - Target Coding - Medicare Quick Guide - 2024 (58.3 KB) | Available after Purchase | ||
| 63 - Medicare Chiropractic Re-examination (30.5 KB) | Available after Purchase | ||
| 40 - LOMN for Spinal Decompression Therapy (21.1 KB) | Available after Purchase | ||
| 64 - Medicare Notice for Non-Covered Services (20.2 KB) | Available after Purchase | ||
| 65 - ABN for Non-Covered Services - 01.31.2026 (30.8 KB) | Available after Purchase | ||
| 67 - ABN for Non-Par & Non-Assignment - 01.31.26 (30.9 KB) | Available after Purchase | ||
| 68 - ABN for Dual Eligibility - 01.31.2026 (34.8 KB) | Available after Purchase | ||
| 70 - ABN for Acupuncture - 01.31.2026 (30.6 KB) | Available after Purchase | ||
| 39 - LOMN for Taping (20.2 KB) | Available after Purchase | ||
| 61 - Medicare Initial Chiropractic Visit (29.4 KB) | Available after Purchase | ||
| 69 - Blank ABN Form - 01.31.26 (25.6 KB) | Available after Purchase | ||
| 70 - ABN for Acupuncture - 01.31.2026 (30.6 KB) | Available after Purchase | ||
| 36 - SOAP Note #10 - Wellness with Symptoms (21.6 KB) | Available after Purchase | ||
| 38 - LOMN for Laser Therapy (19.1 KB) | Available after Purchase | ||
| 71 - Medicare Advantage Plan OON Non-Covered Services (20.4 KB) | Available after Purchase | ||
| 62 - Medicare Subsequent Visit (26.1 KB) | Available after Purchase | ||
| 2 - Patient HIPAA Signature Page (29 KB) | Available after Purchase | ||
| 4 - Patient Request to Restrict PHI (29.8 KB) | Available after Purchase | ||
| 5 - Request Confidential Information (27.9 KB) | Available after Purchase | ||
| 82 - Medicare Advantage Plan OON Non-Covered Services (22.1 KB) | Available after Purchase | ||
| 50 - Spinal CMT & 97140 on the Same Day (16.4 KB) | Available after Purchase | ||
| 58 - Acupuncture SOAP Note (23.8 KB) | Available after Purchase | ||
| 1 - HIPAA Notice with Signature Page (37.2 KB) | Available after Purchase | ||
| 9 - Accounting of Disclosures Log (27.8 KB) | Available after Purchase | ||
| 48 - LOMN for Additional Chiropractic Visits (21.7 KB) | Available after Purchase | ||
| 56 - Physical Therapy Re-evaluation (20.6 KB) | Available after Purchase | ||
| 8 - Patient Complaint Form (29.1 KB) | Available after Purchase | ||
| 6 - Patient Request to Amend Records (27.9 KB) | Available after Purchase | ||
| 72 - Medicare Advantage Plan In-Network Non-Covered Services (21 KB) | Available after Purchase | ||
| 47 - LOMN for Cervical Collar (19.3 KB) | Available after Purchase | ||
| 66 - ABN for Chiropractic Maintenance - 01.31.26 (30.8 KB) | Available after Purchase | ||
| 10 - Patient Request for Disclosures Log (27.7 KB) | Available after Purchase | ||
| 12 - Media Disposal Log (29 KB) | Available after Purchase | ||
| 16 - Employee Acknowledgement Form (27.4 KB) | Available after Purchase | ||
| 17 - Employee Training Log (27.6 KB) | Available after Purchase | ||
| 7 - Testimonial Consent & Release (29.1 KB) | Available after Purchase | ||
| 2 - Patient Update Questionnaire (24 KB) | Available after Purchase | ||
| 49 - Re-exam & Spinal CMT on the Same Day (16.4 KB) | Available after Purchase | ||
| 23 - Annual Checklist & Action Plan Calendar (30.1 KB) | Available after Purchase | ||
| 11 - Security Response Log (27.7 KB) | Available after Purchase | ||
| 71 - No Surprise Law & GFE Forms (27.7 KB) | Available after Purchase | ||
| 67 - ABN for Non-Par & Non-Assignment - 01.31.26 (30.9 KB) | Available after Purchase | ||
| 77 - Neck Index Score - Y (112.3 KB) | Available after Purchase | ||
| 78 - Low Back Index Score - Y (222.1 KB) | Available after Purchase | ||
| 13 - Removal of PHI Log (29.2 KB) | Available after Purchase | ||
| 3 - Authorization to Release Information (29.8 KB) | Available after Purchase | ||
| 14 - Receipt of PHI Log (29.3 KB) | Available after Purchase | ||
| 21 - Employee Exit Interview (27.4 KB) | Available after Purchase | ||
| 18 - Employee Computer Access Form (27.5 KB) | Available after Purchase | ||
| 15 - Compliance Officer Form (27.6 KB) | Available after Purchase | ||
| 20 - Employee Exclusion & Background Check (28.2 KB) | Available after Purchase | ||
| 22 - Bus. Assoc. Agreement (29.7 KB) | Available after Purchase | ||
| 19 - Employee Compliance Concern Form (27 KB) | Available after Purchase | ||
| 1 - HIPAA Notice with Signature Page (37.2 KB) | Available after Purchase | ||
| 2 - Patient HIPAA Signature Page (29 KB) | Available after Purchase | ||
| 4 - Patient Request to Restrict PHI (29.8 KB) | Available after Purchase | ||
| 3 - Authorization to Release Information (29.8 KB) | Available after Purchase | ||
| 12 - Media Disposal Log (29 KB) | Available after Purchase | ||
| 5 - Request Confidential Information (27.9 KB) | Available after Purchase | ||
| 14 - Receipt of PHI Log (29.3 KB) | Available after Purchase | ||
| 8 - Patient Complaint Form (29.1 KB) | Available after Purchase | ||
| 15 - Compliance Officer Form (27.6 KB) | Available after Purchase | ||
| 6 - Patient Request to Amend Records (27.9 KB) | Available after Purchase | ||
| 7 - Testimonial Consent & Release (29.1 KB) | Available after Purchase | ||
| 10 - Patient Request for Disclosures Log (27.7 KB) | Available after Purchase | ||
| 9 - Accounting of Disclosures Log (27.8 KB) | Available after Purchase | ||
| 11 - Security Response Log (27.7 KB) | Available after Purchase | ||
| 13 - Removal of PHI Log (29.2 KB) | Available after Purchase | ||
| 22 - Bus. Assoc. Agreement (29.7 KB) | Available after Purchase | ||
| 16 - Employee Acknowledgement Form (27.4 KB) | Available after Purchase | ||
| 17 - Employee Training Log (27.6 KB) | Available after Purchase | ||
| 18 - Employee Computer Access Form (27.5 KB) | Available after Purchase | ||
| 19 - Employee Compliance Concern Form (27 KB) | Available after Purchase | ||
| 20 - Employee Exclusion & Background Check (28.2 KB) | Available after Purchase | ||
| 21 - Employee Exit Interview (27.4 KB) | Available after Purchase | ||
| 23 - Annual Checklist & Action Plan Calendar (30.1 KB) | Available after Purchase | ||
| 73 - Target Coding - Medicare Quick Guide - 2024 (58.3 KB) | Available after Purchase | ||
| 61 - Medicare Initial Chiropractic Visit (29.4 KB) | Available after Purchase | ||
| 62 - Medicare Subsequent Visit (26.1 KB) | Available after Purchase | ||
| 63 - Medicare Chiropractic Re-examination (30.5 KB) | Available after Purchase | ||
| 64 - Medicare Notice for Non-Covered Services (20.2 KB) | Available after Purchase | ||
| 65 - ABN for Non-Covered Services - 01.31.2026 (30.8 KB) | Available after Purchase | ||
| 66 - ABN for Chiropractic Maintenance - 01.31.26 (30.8 KB) | Available after Purchase | ||
| 67 - ABN for Non-Par & Non-Assignment - 01.31.26 (30.9 KB) | Available after Purchase | ||
| 68 - ABN for Dual Eligibility - 01.31.2026 (34.8 KB) | Available after Purchase | ||
| 69 - Blank ABN Form - 01.31.26 (25.6 KB) | Available after Purchase | ||
| 70 - ABN for Acupuncture - 01.31.2026 (30.6 KB) | Available after Purchase | ||
| 71 - Medicare Advantage Plan OON Non-Covered Services (20.4 KB) | Available after Purchase | ||
| 72 - Medicare Advantage Plan In-Network Non-Covered Services (21 KB) | Available after Purchase | ||
| 10 - Non-Covered Services Form (21.8 KB) | Available after Purchase | ||
| 27 - SOAP Note #1 - Fill in (35.8 KB) | Available after Purchase | ||
| 28 - SOAP Note #2 - 98941, 97110, 97140 (75.9 KB) | Available after Purchase | ||
| 72 - Target Coding - Quick Guide - Spine - 2025 (60.4 KB) | Available after Purchase | ||
| 73 - Target Coding - Quick Guide - Extremity - 2024 (42.8 KB) | Available after Purchase | ||
| 74 - Target Coding - Quick Guide - Head, Ribs, SI, & Non-Neuro - 2024 (31.7 KB) | Available after Purchase | ||
| 75a - Target Coding - Quick Guide - Personal Injury - pg 1 - 2024 (46 KB) | Available after Purchase | ||
| 75b - Target Coding - Quick Guide - Personal Injury - pg 2 - 2024 (41.5 KB) | Available after Purchase | ||
| 76 - Target Coding - Medicare Quick Guide - 2025 (57.2 KB) | Available after Purchase | ||
| 83 - SOAP Note with Checklist - 98941, 98943, 97110, 97012 (31.3 KB) | Available after Purchase | ||
| 84 - Sample Patient Care Plan & Financial Agreement (140.5 KB) | Available after Purchase | ||
| 85 - Target Coding - ICD-10 Justification Sheets (321.9 KB) | Available after Purchase | ||
| 1 - New Patient Health History (23.4 KB) | Available after Purchase | ||
| 2 - Patient Update Questionnaire (24 KB) | Available after Purchase | ||
| 3 - Review of Systems Form (33.1 KB) | Available after Purchase | ||
| 4 - Authorization & Assignment (15.5 KB) | Available after Purchase | ||
| 5 - Lien - Letter of Protection (21.9 KB) | Available after Purchase | ||
| 7 - General Office Policy (17.6 KB) | Available after Purchase | ||
| 8 - Patient Financial Policy (20.9 KB) | Available after Purchase | ||
| 11 - HSA Statement without Codes (28.2 KB) | Available after Purchase | ||
| 9 - Financial Hardship Form Update (17.8 KB) | Available after Purchase | ||
| 12 - HSA Statement with Codes (28.2 KB) | Available after Purchase | ||
| 13 - HSA Statement for Maintenance & Wellness (28.2 KB) | Available after Purchase | ||
| 14 - Consent to Treat Minor Form (20.9 KB) | Available after Purchase | ||
| 15 - Insurance Check Goes To Patient (19.2 KB) | Available after Purchase | ||
| 17 - Cell Phone Policy (15.7 KB) | Available after Purchase | ||
| 16 - Insurance Verification Form (25.3 KB) | Available after Purchase | ||
| 18 - Attorney Records Request (18 KB) | Available after Purchase | ||
| 19 - Examination Form (44 KB) | Available after Purchase | ||
| 22 - ASH Re-Evaluation MNR - Tier 3 (29.3 KB) | Available after Purchase | ||
| 24 - PI Initial Report (40.5 KB) | Available after Purchase | ||
| 20 - Chiropractic Treatment Plan (28.9 KB) | Available after Purchase | ||
| 21 - Chiropractic Re-examination (28.9 KB) | Available after Purchase | ||
| 29 - SOAP Note #3 - 98941, 97110, 97012 (22.6 KB) | Available after Purchase | ||
| 40 - LOMN for Spinal Decompression Therapy (21.1 KB) | Available after Purchase | ||
| 47 - LOMN for Cervical Collar (19.3 KB) | Available after Purchase | ||
| 49 - Re-exam & Spinal CMT on the Same Day (16.4 KB) | Available after Purchase | ||
| 23 - Cash Wellness Re-exam (23.2 KB) | Available after Purchase | ||
| 48 - LOMN for Additional Chiropractic Visits (21.7 KB) | Available after Purchase | ||
| 25 - PI Final Report (30.3 KB) | Available after Purchase | ||
| 31 - SOAP Note #5 - 98941, 97530, 97112 (23.2 KB) | Available after Purchase | ||
| 30 - SOAP Note #4 - 98940, 97110, 97112 (22.6 KB) | Available after Purchase | ||
| 50 - Spinal CMT & 97140 on the Same Day (16.4 KB) | Available after Purchase | ||
| 51 - Spinal CMT & 97124 on the Same Day (16.4 KB) | Available after Purchase | ||
| 32 - SOAP Note #6 - 98940, 97110, 97140 (24 KB) | Available after Purchase | ||
| 26 - Radiology Report (22.2 KB) | Available after Purchase | ||
| 36 - SOAP Note #10 - Wellness with Symptoms (21.6 KB) | Available after Purchase | ||
| 33 - SOAP Note #7 - PI - 98940, 97110, 97140 (23.3 KB) | Available after Purchase | ||
| 34 - SOAP Note #8 - Massage - 97124 (22.2 KB) | Available after Purchase | ||
| 37 - LOMN for ADLs (18.2 KB) | Available after Purchase | ||
| 38 - LOMN for Laser Therapy (19.1 KB) | Available after Purchase | ||
| 35 - SOAP Note #9 - Wellness no Symptoms (21.4 KB) | Available after Purchase | ||
| 39 - LOMN for Taping (20.2 KB) | Available after Purchase | ||
| 44 - LOMN for Support Pillow (18.9 KB) | Available after Purchase | ||
| 55 - Physical Therapy SOAP Note (36.4 KB) | Available after Purchase | ||
| 43 - LOMN for Orthotics (19.3 KB) | Available after Purchase | ||
| 41 - LOMN for Vibration Therapy (21.1 KB) | Available after Purchase | ||
| 42 - LOMN for Varidesk - Stand-Up Desk (19.1 KB) | Available after Purchase | ||
| 52 - Sample DC Treatment Summary (21.4 KB) | Available after Purchase | ||
| 59 - Acupuncture Re-examination (26.9 KB) | Available after Purchase | ||
| 61 - Medicare Initial Chiropractic Visit (29.4 KB) | Available after Purchase | ||
| 45 - LOMN for Back Braces (19.2 KB) | Available after Purchase | ||
| 53 - Physical Therapy Referral & Order Form (19.5 KB) | Available after Purchase | ||
| 62 - Medicare Subsequent Visit (26.1 KB) | Available after Purchase | ||
| 64 - Medicare Notice for Non-Covered Services (20.2 KB) | Available after Purchase | ||
| 56 - Physical Therapy Re-evaluation (20.6 KB) | Available after Purchase | ||
| 60 - Acupuncture & Medicare Financial Disclosure (15 KB) | Available after Purchase | ||
| 63 - Medicare Chiropractic Re-examination (30.5 KB) | Available after Purchase | ||
| 66 - ABN for Chiropractic Maintenance - 01.31.26 (30.8 KB) | Available after Purchase | ||
| 57 - Acupuncture Treatment Plan (27.6 KB) | Available after Purchase | ||
| 58 - Acupuncture SOAP Note (23.8 KB) | Available after Purchase | ||
| 67 - ABN for Non-Par & Non-Assignment - 01.31.26 (30.9 KB) | Available after Purchase | ||
| 71 - No Surprise Law & GFE Forms (27.7 KB) | Available after Purchase | ||
| 68 - ABN for Dual Eligibility - 01.31.2026 (34.8 KB) | Available after Purchase | ||
| 77 - Neck Index Score - Y (112.3 KB) | Available after Purchase | ||
| 54 - Physical Therapy Plan of Care (33.6 KB) | Available after Purchase | ||
| 46 - LOMN for TENS (21.3 KB) | Available after Purchase | ||
| 78 - Low Back Index Score - Y (222.1 KB) | Available after Purchase | ||
| 79 - Upper Extremity Index Score - Y (40.5 KB) | Available after Purchase | ||
| 82 - Medicare Advantage Plan OON Non-Covered Services (22.1 KB) | Available after Purchase | ||
| 81 - Medicare Advantage Plan In-Network Non-Covered Services (22.7 KB) | Available after Purchase | ||
| 65 - ABN for Non-Covered Services - 01.31.2026 (30.8 KB) | Available after Purchase | ||
| 70 - ABN for Acupuncture - 01.31.2026 (30.6 KB) | Available after Purchase | ||
| 80 - Lower Extremity Index Score - Y (26.7 KB) | Available after Purchase | ||
| 69 - Blank ABN Form - 01.31.26 (25.6 KB) | Available after Purchase | ||
| 86 - Foot Levelers Billing and Coding Guide (3.6 MB) | Available after Purchase | ||