FPM Toolbox

Care Management

Agenda-Setting Algorithm

An algorithm that details the steps involved in setting an agenda with the patient for the office visit
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Ambulatory Patient Checklist for MAs

A checklist designed to help medical assistants and other midlevel providers remember key steps in a patient's visit
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Checklist: Emergency Supplies for Family Medicine Offices

A list of medical equipment, medications, and other supplies that may be needed during an office emergency
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Community-Based Organization Referral Form

A template that includes the essential information needed by each office that can be easily incorporated into the office routine.
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Controlled Substance Refill Program: Patient Agreement Form

An agreement patients sign indicating they understand and will comply with the practice's rules for opioid use
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Controlled Substance Refill Program: Patient Enrollment Form

A form used to enroll patients in a practice's program for managing controlled substance refills
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Exercise Diary

A diary to help patients track their daily exercise
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Food Diary

A diary to help patients track what they've eaten to aid in weight loss or other health matters
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General Symptom Diary

A diary to help patients track general symptoms to aid in diagnosis
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Headache Diary

A diary to help patients track their headache symptoms
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Health Confidence Measure

A tool for assessing patients' confidence in their ability to control and manage their health problems
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Immunization Reminder Letter

A letter to remind parents/guardians that a child is due for immunizations
Download Format : Word
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Mock Emergency Evaluation Form

A form for evaluating your practice's response to a mock emergency situation
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Post-Appointment Order Sheet

A check-box order sheet that allows you to order tests and then hand off the form to your receptionist to schedule them
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Practice Management Pearls

A set of practice management pearls to help new physicians handle common problems: angry patients, patients with lists, physician-patient communication, and refills
Download Format : Word
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Preventive Visit Algorithm: Patients Ages 18-64

A summary of preventive services suggested for patients ages 18 to 64 years
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Refill Protocol

A spreadsheet that assists office staff in managing patients' refill requests
Download Format : Excel
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State-by-State Prescribing Laws

A list of state laws regarding the maximum length of prescriptions
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Tracking Book for Unresolved Issues

An example of a tracking book that can be used as a reminder for following up on patients' test results or other unresolved issues
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