FPM Toolbox

Patient Handouts

Avoiding Counterfeit Drugs

A handout to advise your patients on how to avoid purchasing counterfeit medicines
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Blood Pressure

A sample patient handout that helps patients focus on their health care goals by listing critical measures for their condition, explaining what those numbers mean and offering strategies for improvement
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Chronic Pain and Opioid Medication Policies

An example of a handout given to patients who have chronic pain explaining the practice's policies for opioid medication therapy, including the patient's responsibilities to remain a recipient of pain therapy as well as the practice's obligations to provide good care
Download Format : PDF
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Evaluating the Need for an Interpreter (Spanish)

A patient handout that will help explain to Spanish-speaking patients what they can expect when using an interpreter (an English translation is also available)
PDF
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Exercise Diary

A diary to help patients track their daily exercise
Download Format : PDF
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First Visit

A handout that can be mailed to new patients prior to their first visit to acquaint them with the practice
Download Format : Word
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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
Download Format : PDF
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General Symptom Diary

A diary to help patients track general symptoms to aid in diagnosis
Download Format : PDF
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Headache Diary

A diary to help patients track their headache symptoms
Download Format : PDF
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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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Medical Error Prevention

A patient handout that provides 20 tips for preventing medical errors
Download Format : PDF
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Medication Use Agreement

A form that patients being prescribed drugs for chronic pain can sign to signal their agreement not to misuse the drugs
Download Format : PDF
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Mourner's Rights

A patient-education handout that helps prevent health crises in mourning patients and demonstrates that the physician cares
Download Format : PDF
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Patient Assistance Contract

A contract to help patients enrolled in pharmaceutical assistance programs understand their responsibilities
Download Format : PDF Word
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Patient Welcome

A sample welcome letter for new patients at their first office visit
Download Format : Word
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Patient-Physician Partnership Agreement

An agreement for both a patient with a chronic disease, such as diabetes, and a physician to sign as a step toward better managing a patient's disease
Download Format : PDF
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Prescription Assistance

A patient handout that describes how patients can get medicine for a reduced cost
Download Format : PDF
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Prescriptions

A patient handout that explains the concepts and financial implications of formularies, preferred and nonpreferred drugs and brand name and generic drugs
Download Format : PDF
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Sample new patient letter

A sample of a letter a physician would provide to a new patient, laying out the practice's approach to scheduling and canceling appointments, after-hours contact, and clinical services that are available
Download Format : Word
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Sleep Diary

A diary to help patients track their sleep patterns
Download Format : PDF
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Specialty Referrals and Managed Care

A patient handout that clarifies the details of specialty referrals and managed care
Download Format : Word
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Sports Physicals

A patient handout to explain to parents why they may need to schedule a well-child exam rather than a "sports physical" for their child
Download Format : Word
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Understanding Your Health Plan's Rules

A patient handout that explains the general rules associated with referrals, preauthorizations, formularies, and participating providers
Download Format : PDF
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Understanding Your Insurance Coverage

A patient handout that explains the concepts and financial implications of medical necessity and medical benefits and covered and noncovered services
PDF
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Understanding Your Medical Bills

A patient handout that assists physicians in dealing with questions patients may ask and with problems that arise when patients misunderstand their insurance benefits
Download Format : PDF
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Visit Summary

An information sheet that summarizes the most important points of the patient’s visit and explains what he or she needs to do after leaving your office
Download Format : PDF
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Voiding Diary

A diary to help patients track their voiding patterns
Download Format : PDF
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Warfarin Dose Reminder Chart

A chart to help patients remember the correct dose of warfarin
Download Format : PDF
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