FPM Toolbox

The FPM Toolbox offers more than 150 practice management tools, many of which you can download – free of charge. To browse the FPM Toolbox, simply click on one of the categories listed below.

Claim correction form
A one-page form that can help make the process of filing corrected claims more efficient
Tool as published
Download format: PDF (printer friendly), MS Word (modifiable)
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Medication refill request
A simple form that helps physicians and office staff manage patients' refill requests
Tool as published
Download format: PDF (printer-friendly)
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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
Tool as published
Download format: PDF (printer-friendly)
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Practice management pearls
Tips to help new physicians manage four problematic areas: physician-patient communication, patients with lists, refills and angry patients
Tool as published
Download format: MS Word (modifiable)
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Refill protocol
A spreadsheet that assists office staff in managing patients' refill requests
Tool as published
Download format: MS Excel
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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' unresolved issues
Tool as published
Source article

Interview questions
A list of questions to ask physicians, nurses, support staff and administrators when interviewing for a new practice
Tool as published
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Negotiation leverage
Twenty questions for determining how much leverage a physician will have when negotiating a salary and other terms
Tool as published
Download format: PDF (printer friendly)
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Physician performance evaluation
A qualitative self-evaluation for physicians that consists of open-ended questions about their practices
Tool as published
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Worksheet: Identifying your key job issues
Three exercises to help you identify the key issues to guide your job search
Tool as published
Download format: PDF (printer-friendly)
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Coding frequency comparison spreadsheet
A spreadsheet that enables physicians to easily compare their coding frequencies with one another and with national benchmarks
Tool as published
Download format: MS Excel
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CPT Code Changes 2008
A partial listing of CPT changes for 2008 that may affect family practices
Download format: PDF (printer friendly)
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Established Patient Level-IV Visit Worksheet
A worksheet to help you quickly assess whether a patient encounter qualifies as a level-IV visit
Tool as published
Download format: PDF (printer friendly)
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FPM Superbill
A superbill to capture the codes most common in office-based outpatient practice
Download format: PDF (printer friendly), MS Excel
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Guidelines for time-based coding
A summary of CPT's prolonged services guidelines and associated average visit times
Tool as published
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House calls
A comparison of new and established patient CPT codes for house calls and similar office visit codes
Tool as published
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Medical Decision-Making Reference
Tables to calculate your level of medical decision making for routine established-patient office visits
Tool as published
Download format: PDF (printer friendly)
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Office visits: Level I
A quick reference for identifying the key components, elements and minimum requirements necessary for documenting a 99201 new patient visit
Tool as published
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Office visits: Level IV
A reference card for CPT code 99214 that lists the key components, elements and requirements necessary for documenting the code and shows how the requirements for 99214 differ from 99204
Tool as published
Download format: PDF (printer friendly)
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PQRI data collection sheet: Complete list
A data collection sheet to help you report measures and select quality codes for Medicare's 2007 Physician Quality Reporting Initiative
Download format: MS Excel
Source article

PQRI data collection sheet: Diabetes measures
A data collection sheet to help you report diabetes measures and select quality codes for Medicare's 2007 Physician Quality Reporting Initiative
Tool as published
Download format: MS Excel
Source article

FPM Superbill
A superbill to capture the codes most common in office-based outpatient practice
Download format: PDF (printer friendly), MS Excel
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ICD-9 coding references (2007-2008)
Four annually updated ICD-9 coding tools: (1) A list of all the new and changed ICD-9 codes for the year, (2) the FPM Short List of about 600 ICD-9 codes commonly used in family medicine, (3) the FPM Long List of about 1,500 ICD-9 codes commonly used in family medicine, and (4) an easily searchable PDA database of ICD-9 codes adapted from the FPM Long List.
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Asthma
A documentation form to identify important elements of care that are recommended for asthma visits
Tool as published
Download format: PDF (printer friendly)
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Checklist of care plan oversight requirements
A checklist to determine if you have a situation that meets the physician and beneficiary requirements for CPO
Tool as published
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Decision tree for new and established patients
A decision tree for determining if a patient is new or established
Tool as published
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Documentation requirements for established patient office visits
A table that shows the history, exam and medical decision making requirements for each of the established patient office visit codes
Tool as published
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Documentation requirements for new and established patient office visits
A table that shows the documentation requirements for new and established patient office visits
Tool as published
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Encounter form: Acute otitis media
An evidence-based encounter form for acute otitis media
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Download format: PDF (printer friendly)
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Encounter form: Acute knee injury
An evidence-based encounter form for acute knee injury
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Encounter form: Diabetes
An encounter form for use in documenting diabetes-related visits and ensuring that key issues are not overlooked during the visit
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Encounter form: E/M visit
An encounter form for E/M visits that includes a checklist designed to make it easier to count systems and body areas
Tool as published
Download format: PDF (printer friendly)
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Encounter form: Group visits (diabetes)
An encounter form designed to enable physicians to complete much of their documentation prior to a diabetes group visit
Tool as published
Download format: PDF (printer friendly), MS Word (modifiable)
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Encounter form: Group visits (nursing home)
An encounter form for documenting the history of present illness and physical exams at nursing-home group visits
Tool as published
Download format: MS Word (modifiable)
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Encounter form: House calls
An encounter form that guides physicians through the necessary home assessment, encourages accurate coding and helps document the necessity of the home visit
Tool as published
Download format: PDF (printer friendly), MS Word (modifiable)
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Encounter form: Hypertension
An evidence-based encounter form for evaluating hypertension
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Encounter form: Pulmonary embolism
An evidence-based encounter form for pulmonary embolism
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Encounter form: Sore throat
An evidence-based encounter form for sore throats
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Download format: PDF (printer friendly)
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Encounter form: Well-male visit
A well-male exam encounter form that includes a patient-completed history, an exam documentation template and evidence-based screening test recommendations for all age groups
Tool as published
Download format: PDF (printer friendly), MS Word (modifiable)
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Encounter form: Well-woman visit (one-page version)
A visit-specific encounter form that shifts the responsibility for collecting patients’ health information to the patient and gives physicians more time during the encounter for preventive counseling or patient education
Tool as published
Download format: PDF (printer friendly)
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Encounter form: Well-woman visit (three-page version)
A well-woman exam encounter form that includes a patient-completed history, an exam documentation template and evidence-based screening test recommendations for all age groups
Tool as published
Download format: PDF (printer friendly), MS Word (modifiable)
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Integrated summary template
A one-page template that summarizes the patient's health by including a problem list, medication list, past medical history, flow-sheet parameters, etc.
Tool as published
Download format: PDF (printer friendly)
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EHR demonstration rating form
A rating form to be completed by each person in your group who observes an EHR vendor demonstration
Tool as published
Download format: PDF (printer friendly)
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EHR five-year cost/benefit & increased annual E/M revenue worksheets
Two worksheets to help you estimate the net annual benefit and the net increase in E/M revenue to be derived from an EHR system either per physician or for a whole practice
Tool as published
Download format: MS Excel
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EHR functionality list
A list to help you organize your priorities in terms of EHR functionality
Tool as published
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EHR vendor rating tool
A rating form to evaluate each EHR product your group is considering
Tool as published
Download format: PDF (printer friendly)
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EMR cost-analysis spreadsheet
A spreadsheet that calculates the initial purchase price of a complete electronic medical record (EMR) system as well its annual and five-year operating costs
Tool as published
Download format: MS Excel
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EMR cost-savings calculator
A calculator that helps physicians determine their annual transcription costs
Tool as published
Download format: MS Excel
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EMRs: Evaluation criteria
A list of criteria that electronic medical record (EMR) systems should have to be family-physician friendly
Tool as published
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EMRs: Vendor survey
FPM's latest survey of electronic medical record (EMR) vendors
Tool as published
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PDA software evaluation
A worksheet to evaluate the content, time saved and cost-effectiveness of PDA software
Tool as published
Download format: MS Word (modifiable)
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Questions to ask EHR references
A list of questions to ask other practices about their experience with the EHRs you're considering purchasing
Tool as published
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Request for proposal (RFP) outline
An outline that tells your prospective EHR vendor about your practice, its resources and your priorities in terms of EHR functionality
Tool as published
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Fire checklist
An office-fire checklist that addresses what to do before and during a fire
Tool as published
Download format: PDF (printer friendly)
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Fire drill evaluation form
A form for evaluating the effectiveness of an office fire drill
Tool as published
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Off-site necessities kit
A list of materials a practice may need to store off site in case an emergency denies staff access to the office
Tool as published
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Encounter form
A documentation form to identify important elements of care that are recommended for asthma visits
Tool as published
Download format: PDF (printer friendly)
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Chart reminder
A reminder to place in the charts of patients with asthma to aid physicians in providing the recommended treatment
Tool as published
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Checkup questionnaire
An annual questionnaire that helps patients with diabetes think about their health care goals and identify areas in which they may need assistance
Tool as published
Download format: PDF (printer friendly)
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Diabetes registry
A sample spreadsheet to track interventions and parameters for diabetes management
Tool as published
Download format: MS Excel
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Encounter form
An encounter form for use in documenting diabetes-related visits and ensuring that key issues are not overlooked during the visit
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Download format: PDF (printer friendly)
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Flow sheet
A flow sheet for recording patients’ essential diabetes measures, such as A1c rates, over time
Tool as published
Download format: PDF (printer friendly), MS Word (modifiable)
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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
Tool as published
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PQRI data collection sheet: Diabetes measures
A data collection sheet to help you report diabetes measures and select quality codes for Medicare's 2007 Physician Quality Reporting Initiative
Tool as published
Download format: MS Excel
Source article

Reminder letter
A letter that reminds patients they are due for a diabetes checkup and instructs them of the tests they need to have completed before their visit
Tool as published
Download format: PDF (printer friendly)
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Clinic-level pandemic influenza planning form
A form to estimate the total number of people affiliated with your clinic who might need the pandemic influenza vaccine
Download format: PDF (printer friendly)
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Patient priority groups and database parameters worksheet
A form with suggested database search parameters to quickly identify patients in each priority tier group for pandemic influenza vaccines
Download format: PDF (printer friendly)
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Primary care clinic staff worksheet
A worksheet to ensure you’ve accounted for all employees when estimating your clinic’s need for pandemic influenza vaccine
Download format: PDF (printer friendly)
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Acute knee injury
An evidence-based encounter form for acute knee injury
Tool as published
Download format: PDF (printer friendly)
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Acute otitis media
An evidence-based encounter form for acute otitis media
Tool as published
Download format: PDF (printer friendly)
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Asthma
A documentation form to identify important elements of care that are recommended for asthma visits
Tool as published
Download format: PDF (printer friendly)
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Common Skin Procedure Form
An encounter form to simplify documenting and coding common skin procedures
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Download format: PDF (printer friendly)
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Diabetes
A progress note for use in documenting diabetes-related visits and ensuring that key issues are not overlooked during the visit
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Download format: PDF (printer friendly)
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E/M visit
A progress note for E/M visits that includes a checklist designed to make it easier to count systems and body areas
Tool as published
Download format: PDF (printer friendly)
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Group visits (diabetes)
A progress note designed to enable physicians to complete much of their documentation prior to a diabetes group visit
Tool as published
Download format: PDF (printer friendly), MS Word (modifiable)
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Group visits (nursing home)
A progress note for documenting the history of present illness and physical exams at nursing-home group visits
Tool as published
Download format: PDF (printer friendly), MS Word (modifiable)
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House calls
A progress note that guides physicians through the necessary home assessment, encourages accurate coding and helps document the necessity of the home visit
Tool as published
Download format: PDF (printer friendly), MS Word (modifiable)
Source article

Hypertension
An evidence-based encounter form for evaluating hypertension
Tool as published
Download format: PDF (printer friendly)
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Medicare initial preventive physical examination encounter form
An encounter form to ensure all elements of the initial preventive physical exam are completed
Tool as published
Download format: PDF (printer friendly), MS Word (modifiable)
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Pertussis screening form
A form to use throughout the process of contacting and treating patients who might have been exposed to pertussis
Tool as published
Download format: PDF (printer friendly)
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Pulmonary embolism
An evidence-based encounter form for pulmonary embolism
Tool as published
Download format: PDF (printer friendly)
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Sore throat
An evidence-based encounter form for sore throats
Tool as published
Download format: PDF (printer friendly)
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Upper respiratory infection encounter form
An encounter form for patients with upper respiratory infection symptoms that includes a patient questionnaire section and a physician evaluation section
Tool as published
Download format: PDF (printer friendly), MS Word (modifiable)
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Well-male visit
A well-male exam encounter form that includes a patient-completed history, an exam documentation template and evidence-based screening test recommendations for all age groups
Tool as published
Download formats: PDF (printer friendly), MS Word (modifiable)
Source article

Well-woman visit (one-page version)
A visit-specific encounter form that shifts the responsibility for collecting patients’ health information to the patient and gives physicians more time during the encounter for preventive counseling or patient education
Tool as published
Download format: PDF (printer friendly)
Source article

Well-woman visit (three-page version)
A well-woman exam encounter form that includes a patient-completed history, an exam documentation template and evidence-based screening test recommendations for all age groups
Tool as published
Download formats: PDF (printer friendly), MS Word (modifiable)
Source article

Chart of accounts template
A sample template used to track and compare a practice's expenses
Tool as published
Download format: MS Excel
Source article

E/M vs. procedural services reimbursement spreadsheet
A spreadsheet for analyzing your payers' fees for selected E/M and procedural services
Tool as published
Download format: MS Excel
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Financial analysis: Buying medical equipment
A spreadsheet that helps you estimate the financial feasibility of buying new medical equipment for your practice
Tool as published
Download format: MS Excel
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Financial evaluation matrix
A sample matrix used to compare financial and other measures of numerous practice sites
Tool as published
Download format: MS Excel
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Medicare cut impact tool
A tool to estimate the impact a Medicare fee cut would have on your practice
Tool as published
Download format: MS Excel
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Residency program finances
A model for capturing the more elusive contributions a residency program makes to its sponsoring institution
Tool as published
Download format: MS Word (modifiable)
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Unit cost analysis
An example of a unit cost analysis that can be used to calculate your costs per visit
Tool as published
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Depo-progesterone injections
A flow sheet that helps nurses properly document patients' depo-progesterone visits
Tool as published
Download format: PDF (printer friendly)
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Diabetes checkups
A flow sheet for recording patients’ essential diabetes measures, such as A1c rates, over time.
Tool as published
Download format: PDF (printer friendly), MS Word (modifiable)
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Outpatient anticoagulation flow sheet
A flow sheet for recording patients' warfarin doses, including a dosage adjustment algorithm and anticoagulation decision support
Tool as published
Download format: PDF (printer friendly)
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Preventive care
Nine flow sheets that help physicians track whether patients of any age have received the necessary preventive care services
Tool as published
Download formats: PDF (printer friendly), MS Word (modifiable)
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Vital signs
A flow sheet that helps nurses document patients’ vital signs in the chart so that physicians can review them efficiently
Tool as published
Download format: PDF (printer friendly)
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Encounter form (diabetes)
An encounter form designed to enable physicians to complete much of their documentation prior to a diabetes group visit
Tool as published
Download format: PDF (printer friendly), MS Word (modifiable)
Source article

Encounter form (nursing home)
An encounter form for documenting the history of present illness and physical exams at nursing-home group visits
Tool as published
Download format: PDF (printer friendly), MS Word (modifiable)
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Sample invitation
A letter for patients eligible to participate in a practice's group-visit program
Tool as published
Download format: MS Word (modifiable)
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Authorization form
A sample form for obtaining authorization from patients to release their protected health information for reasons other than treatment, payment or health care operations
Tool as published
Download format: MS Word (modifiable)
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Health plan inventory worksheet
A worksheet designed to help physicians organize their HIPAA information and to prepare them to speak with vendors about their HIPAA-readiness
Tool as published
Download format: PDF (printer friendly), MS Word (modifiable)
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Notice of privacy practices
A sample notice that informs patients of their privacy rights and the practice's privacy policies and procedures
Tool as published
Download format: MS Word (modifiable)
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Standardized admission orders
A set of 29 ready-made admission orders for conditions ranging from ASA overdose to chest pain to diabetic ketoacidosis
Download format: PDF (printer friendly), MS Word (modifiable)
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Compassion fatigue
Nine yes or no statements that can help a physician assess his or her risk for compassion fatigue
Tool as published
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Time-management exercise
A quick time-management exercise that shows physicians exactly where they are spending the 168 hours of their week
Tool as published
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Cheat sheet: Formulary
A sample pocket card that indicates health plan's formulary restrictions in nine common drug classes and provides initial doses and dosage ranges
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Cheat sheet: Health plan requirements
A sample cheat sheet that summarizes the requirements of an individual insurance plan and can be attached to charts prior to appointments
Tool as published
Download format: MS Word (modifiable)
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Fee analysis spreadsheet
A spreadsheet to help you identify which reimbursement rates should be negotiated with payers and a corresponding revenue-analysis spreadsheet to help you assess your profits if a payer accepts your target rate
Tool as published
Download format: MS Excel
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Letter to health plans about bundling services
A sample letter to health plans about the inappropriate bundling of preventive medicine services and problem-oriented E/M services on the same date
Tool as published
Download format: MS Word
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Matrix: Ancillary services
A quick reference, based on the patient's insurance, for determining which ancillary center to refer to and how to bill for the service
Tool as published
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Patient panel size worksheet
A worksheet to help you calculate your current and ideal panel size
Tool as published
Download format: MS Excel
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Pay-for-performance evaluation tool
A spreadsheet that can help you evaluate the pay-for-performance programs that are available to you
Tool as published
Download format: MS Excel
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Response to a health plan audit
A sample response to a health plan that identifies you as a coding outlier
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Download format: MS Word (modifiable)
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Spreadsheet: Health plan comparison
A sample spreadsheet that directly compares the value of the health plans a practice does business with
Tool as published
Download format: MS Excel
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Advance beneficiary notice
A form for notifying Medicare patients prior to a service of the likelihood of noncoverage
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Download format: PDF (printer friendly)
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Checklist of care plan oversight requirements
A checklist to determine if you have a situation that meets the physician and beneficiary requirements for CPO
Tool as published
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Medicare cut impact tool
A tool to estimate the impact a Medicare fee cut would have on your practice
Tool as published
Download format: MS Excel
Source article

Medicare initial preventive physical examination encounter form
An encounter form to ensure all elements of the initial preventive physical exam are completed
Tool as published
Download format: PDF (printer friendly), MS Word (modifiable)
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Medicare opt-out notice
An agreement form to notify Medicare that you plan to opt out
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Download format: PDF (printer friendly)
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PQRI data collection sheet: Complete list
A data collection sheet to help you report measures and select quality codes for Medicare's 2007 Physician Quality Reporting Initiative
Download format: MS Excel
Source article

PQRI data collection sheet: Diabetes measures
A data collection sheet to help you report diabetes measures and select quality codes for Medicare's 2007 Physician Quality Reporting Initiative
Tool as published
Download format: MS Excel
Source article

Private contract with Medicare beneficiary
A contract between you and Medicare patients that they are prohibited from submitting claims to Medicare for reimbursement for services you provide
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Download format: PDF (printer friendly)
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Dismissal letter for patients with delinquent accounts
A sample letter to notify patients of their dismissal from the practice due to the outstanding balance on their account
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Download format: MS Word (modifiable)
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Flow chart for managing difficult physician-patient relationships
A flow chart to help physicians deal with challenging patients and advise them when it is necessary to terminate the relationship
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Notice regarding same-day wellness care and illness care
A sample notice to explain your office’s policy of scheduling problem-oriented visits and preventive visits on separate dates
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Download format: MS Word
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Payment policy
An example of a payment policy that lets patients know what the practice expects of them financially and that gives the practice some legal protection if necessary
Tool as published
Download format: MS Word (modifiable)
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Sexual harassment
Sample sexual harassment policies for family practices
Tool as published
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Warning letter for patients with delinquent accounts
A sample letter to warn patients that their account will be sent to a collection agency
Tool as published
Download format: MS Word (modifiable)
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Avoiding counterfeit drugs
A handout to advise your patients on how to avoid purchasing counterfeit medicines
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Download format: PDF (printer-friendly)
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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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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.)
Tool as published
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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
Tool as published
Download format: MS Word (modifiable)
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FPM series on navigating the health care system
Patient handouts designed to help patients understand the health care system and help physicians deal with patients' questions, misunderstandings and unrealistic expectations
Tool as published
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Health plan's rules
A patient handout that explains the general rules associated with referrals, preauthorizations, formularies and participating providers
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Insurance coverage
A patient handout that explains the concepts and financial implications of medical necessity and medical benefits and covered and noncovered services
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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
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Medical error prevention
A patient handout that provides 20 tips for preventing medical errors
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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
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Mourners' rights
A patient-education handout that helps prevent health crises in mourning patients and demonstrates that the physician cares
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Patient assistance contract
A contract to help patients enrolled in pharmaceutical assistance programs understand their responsibilities
Tool as published
Download Format: PDF (printer friendly), MS Word (modifiable)
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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
Tool as published
Download format: PDF (printer friendly)
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Patient welcome
A sample welcome letter for new patients at their first office visit
Tool as published
Download format: MS Word (modifiable)
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Payment policy
An example of a payment policy that lets patients know what the practice expects of them financially and that gives the practice some legal protection if necessary
Tool as published
Download format: MS Word (modifiable)
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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
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Prescription assistance
A patient handout that describes how patients can get medicine for a reduced cost
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Scope of practice
A sample poster that describes the variety of services a family practice offers
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Specialty referrals and managed care
A patient handout that clarifies the details of specialty referrals and managed care
Tool as published
Download format: MS Word (modifiable)
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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
Tool as published
Download format: MS Word (modifiable)
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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
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Download format: PDF (printer friendly)
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Warfarin dose reminder chart
A chart to help patients remember the correct dose of warfarin
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Adult health questionnaire
A list of basic health care questions for new patients designed to gather the patient's history, initiate a dialogue for the exam and help the patient feel more comfortable with a new physician
Tool as published
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Diabetes checkup questionnaire
An annual questionnaire that helps patients with diabetes think about their health care goals and identify areas in which they may need assistance
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Download format: PDF (printer friendly)
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Genogram template
A genogram template for patients' family relationships and medical history that can provide a quick and useful context in which to evaluate an individual's health risks
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Patient phone-system survey
A survey that asks patients to evaluate the efficiency of a practice's phone system
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Pre-appointment questionnaire
A questionnaire to help you understand the patient's primary agenda for the visit
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Download format: PDF (printer-friendly)
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Problem-solving worksheet
A worksheet to help patients set goals that will help them tackle their health problems
Tool as published
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Survey of patient Internet/e-mail capability and interest
A survey to identify patients' ability to communicate with your practice via the Internet
Tool as published
Download format: PDF (printer-friendly)
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Today's visit checklist
A brief checklist for patients that helps them focus their goals for the current visit
Tool as published
Download format: MS Word (modifiable)
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Cause and effect diagram
A diagram to resolve a problem in your office that is created by breakdowns in process
Tool as published
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Chart review: Self-audit form
A form used to evaluate progress notes to determine whether the documentation supports the coding
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Download format: PDF (printer friendly)
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Chart review: Template for findings
A sample template used for recording chart-review findings on influenza vaccinations
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Flow map
A map to depict the steps of a process in your practice, which will help you identify inefficiencies
Tool as published
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Model-for-improvement worksheet
A worksheet that walks physicians through the process of testing changes for improvement in their practices
Tool as published
Download format: PDF (printer friendly)
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Patient panel size worksheet
A worksheet to help you calculate your current and ideal panel size
Tool as published
Download format: MS Excel
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Patient phone-system survey
A survey that asks patients to evaluate the efficiency of a practice's phone system
Tool as published
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Phone call tracking sheet
A form that tracks and categorizes the frequency of inbound calls by type of call for a period of at least five days
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Practice blueprint
A sample map of the care process within a family practice that can be used to identify areas of improvement in scheduling, patient flow, etc.
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Practice self-assessment
A practice self-assessment based on eight components of military structure
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Download format: PDF (printer friendly)
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Practice self-test
A practice self-test designed to give physicians an easy way to evaluate the strengths and weaknesses of their practices
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Download format: PDF (printer friendly)
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Practice vitality assessment
A quick practice assessment designed to help you assess how well your practice meets five measurements of a vital practice
Tool as published
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Sample clinical instrument panel
A tool for tracking a practice's performance in key areas and viewing the data on a single page
Tool as published
Download format: MS Excel
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Sample moment-of-truth worksheet
A sample worksheet that helps physicians analyze the moments of truth in their practices, create a service mind-set and identify priorities for improvement
Tool as published
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Staff job satisfaction
A ratings sheet that evaluates a practice's performance in the area of job satisfaction and identifies where improvement is needed
Tool as published
Download format: PDF (printer friendly)
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Telephone traffic study worksheet
A worksheet to tally the number of incoming calls your office receives every hour
Tool as published
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Call distribution spreadsheet
A spreadsheet that can be used to calculate physicians’ call relative value units (RVUs) and distribute call more equitably
Tool as published
Download format: MS Excel
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Patient panel size worksheet
A worksheet to help you calculate your current and ideal panel size
Tool as published
Download format: MS Excel
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Consultation/referral request form
A form to indicate what you need from the consultant and how you wish to be notified about the patient's progress
Tool as published
Download format: PDF (printer friendly), MS Word (modifiable)
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Sample referral agreement
A sample agreement between clinics intended to reduce waiting times and delays between primary and specialty care by laying out a clear set of guidelines and responsibilities
Tool as published
Download format: MS Word (modifiable)
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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' unresolved issues
Tool as published
Download format: PDF (printer friendly)
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Coronary angioplasty
A risk score calculator for estimating the likelihood of complications from angioplasty
Tool as published
Download format: PDF (printer friendly)
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Coronary heart disease
A score sheet for predicting the risk of coronary heart disease in men or women based on total cholesterol level
Tool as published
Download format: PDF (men), PDF (women)
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CURB-65 and CURB-65 Severity Scores for Community-Acquired Pneumonia
A clinical prediction tool to help guide physicians when deciding on inpatient or outpatient treatment of pneumonia
Tool as published
Download format: PDF (printer-friendly)
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Pneumonia Severity Index for Community-Acquired Pneumonia
A clinical prediction tool to help guide physicians when deciding on inpatient or outpatient treatment of pneumonia
Tool as published
Download format: PDF (printer-friendly)
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Exit interview questions
A list of questions physicians can ask departing staff members to determine the causes of staff turnover and how to prevent it
Tool as published
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Exit survey sample
A written survey for departing employees intended to determine the cause of staff turnover and how to prevent it
Tool as published
Download format: MS Word (modifiable)
Source article

Job description questionnaire
A questionnaire for staff members to identify their work processes and primary tasks
Tool as published
Download format: PDF (printer friendly)
Source article

Performance record
A quarterly performance record that includes a block of space to record th