Family Practice Office Tools

In an effort to gain some control over the documentation nightmare that modern medicine has become, this site was created as a repository for sample templates and office forms for the participants of the practicemgt listserv sponsored by the AAFP. This site is in no way legally connected to the AAFP. Please feel free to download, modify, and use these forms. These examples are shared freely, however, ownership is maintained by their designers. Please do not post these on another website or attempt to use them for commercial gain without the written permission of their designers. To contribute, send a note to info@ackdoc.com. Thank you. It is understood that anyone who uses one of these forms, or a modified version of one of them, takes full responsibility for verifying the medical and legal information contained therein. These have not been peer-reviewed.

ENCOUNTER FORMS

Office Visit (Dr. Henderson) in Word format

Office Visit (Dr. Hinson) in Word format

Office Visit (Dr. Switzer) in Word format

Office Visit (Dr. Ingram) in Word and PDF formats

Self-coding Encounter Form (Dr. Blau) in PDF format (instructions for use)

Coding Encounter Form (Dr. Locke) in Word format

Routine Office Visit (Dr. Gondo) in Word format

Female and Male Office Visit (Dr. Groll) in Word format

Adult New and Established Office Visit forms (Dr. Carpenter) in Word format

Pediatric New and Established Office Visit forms (Dr. Carpenter) in Word format

Prenatal Care Record (Dr. Hinson) in PDF or Adobe Pagemaker (large file) formats

OB Checklist (Dr. Switzer) in Word format

OB Visit Record (Dr. Switzer) in Word format

Brief Office Visit or Phone Call Record (Dr. Hinson) in Word format

URI Visit Template (Dr. Hinson) in Word format

URI Visit Template modified (Dr. Locke) in Word format

UTI Visit Template (Dr. Hinson) in Word format

Back Pain Visit Template (Dr. Hinson) in Word format

Ankle Sprain Template (Dr. Locke) in Word format

History Form for Adults (Dr. Locke) in Word format

Modified Well Woman Exam Form (Dr. Hinson) in PDF format

Anticoagulation Progress Note (Dr. Gondo) in Word format

Coumadin Flow Sheet (Dr. Locke) in Word format

Teleconference and Lab Follow-up Form (Dr. Locke) in Word format

Medication List (Dr. Switzer) in Word format

Diabetes Flow Sheet (Dr. Brewer) in Word format

Diabetes Flow Sheet (Dr. Janzen) in PDF format

Modified Integrated Summary (Dr. Hinson) in Excel format (see FPM, April, 2003 for a description of its use)

Problem List (Dr. Falkoff) in Excel format

Rx List (Dr. Falkoff) in Excel format

Patient Record Face Sheet (Dr. Switzer) in Word format

Sports Physical Form (Dr. Locke) in Word format

Well Child Care Form, 0-2 mos (Dr. Hinson) in Word format

Lab Fair Note (Dr. Locke) in Word format

HIPAA FORMS
Notice of Privacy Practices (Dr. Hinson) in Word format

Acknowledgement of Receipt of Privacy Policy (Dr. Hinson) in Word format

Business Associates Agreement (Dr. Hinson) in Word format

PROCEDURE NOTES

Colposcopy Form (Dr. Hinson) in Word and PDF formats

Procedure Note (Dr. Henderson) in Word format

Skin Biopsy Form (Dr. Locke) in Word format (large file)

Minor Procedure Consent Form (Dr. Locke) in Word format

PATIENT HANDOUT FORMS

Familydoctor.org

Ashtma Action Plan in PDF (large file)

KP Asthma Management Plan in PDF (large file)

Pediatric Tylenol/Motrin Dosing Chart in Word format

Weight Loss Rx (Dr. Switzer) in Word format

SUPERBILLS & CODING

Coding Documentation Requirements in PDF format

Super Bill Outpatient (Dr. Locke) in Word format

Super Bill Inpatient (Dr. Locke) in Word format

ADMIT ORDERS

Dr. Younger's Admission Orders (in Word format)...

Acute Alcohol Intoxication

Acute Bronchitis

Acute Coronary Syndrome

Admission Order Macros

Adult Gastritis

Adult Gastroenteritis

Chronic Daily Headache Detox

Community Aquired Pneumonia

CHF

COPD-Asthma Exacerbation

CVA (2)

D and C

DVT

DVT (Lovenox/Warfarin)

Hyperemesis Gravidarum

Initial Seizure

Insulin Drip for Uncontrolled DM

Medical Detox

Mini-lap BTL

Pediatric Head Injury

Pediatric Vomiting

Post-BTL Discharge

Protocol for ICU IV Insulin

Terminal Care (Hospice)

PRACTICE MANAGEMENT

Patient Satisfaction Survey (Dr. Locke) in Word format

Employee Timesheet Template (Dr. Hinson) in Excel format

Appointment Reminder Card (Dr. Hinson) in Word format

Clinic Hours Survey (Dr. Locke) in Word format

Chronic Opioid Use Contract (Dr. Locke) in Word (large file) format

Clinic Brochure mock-up (Dr. Locke) in Word format

Growth Charts in PDF format in B&W and in color (large files)

Lab Follow-up Letter (Dr. Locke) in Word format

Lipid Results Follow-up Letter (Dr. Locke) in Word format

Flu Shot Reminder Letter (Dr. Locke) in Word format

Lab Results Form Letter (Dr. Gwozdz) in Word format

New Patient Letter (Dr. Locke) in Word format

Attending Physicians Statement & Summary (Dr. Falkoff) in Word format

EMR TEMPLATES
This section contains templates saved in .rtf format that others are using as templates in their EMR software. The files may contain useful text even for those of us using paper charts, i.e., text that can formatted into a printed form. Where known, the software used is mentioned, but the files are likely generic enough to be used in more then one program.

Basic Office Note (Dr. Oenbrink)

EPSDT Template for Practice Partner (Dr. Jackson)

Coumadin Monitoring Template for SOAPware (Dr. Montgomery)

Initial Workmans Compensation Visit (Dr. Newman)

LINKS TO OTHER HELPFUL SITES

AAFP Family Practice Management's the FPM Toolbox

Don Self's Sample Forms

The Coding Center (coding info and tools from the state medical associations of ME, NH, and VT)

Flashcode's free online ICD9 coding tool

Physician's Practice downloadable forms

Medical Economics Clip and Copy

Practice Management Curriculum