FPM Toolbox
Care Management
Download tools to help you manage patient care tasks, from agenda-setting to controlled substance refills.
A Deprescribing Algorithm |
A set of steps to follow in deprescribing medications |
Download Format: PDF |
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A Sample Diabetes Prep Sheet |
A checklist to help medical assistants and other staff identify the tasks that need to be completed to prepare for diabetes visits |
Download Format: PDF |
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ACP/HCA Documentation Workflow |
A visual depiction of the advance care planning/health care agent selection process, involving patients, staff, and clinicians |
Tool as published |
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Agenda-Setting Algorithm |
An algorithm that details the steps involved in setting a visit agenda with the patient |
Download Format: PDF |
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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 |
Download Format: PDF |
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Ask-Tell-Ask Framework for Flu Vaccination |
A three-step process, with examples, for how physicians can discover, understand, and resolve patients' concerns about getting a flu shot |
Download Format: PDF |
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Checklist for Clinic Readiness to Implement SDOH Screening |
A checklist to help practices get started with social determinants of health screening |
Download Format: PDF |
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Chronic Care Management Patient Agreement Form |
A form that facilitates billing Medicare for chronic care management services |
Download Format: PDF |
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Chronic Care Management Patient Letter |
A letter that explains chronic care management services to patients |
Download Format: PDF |
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Chronic Care Management Services Log |
A spreadsheet that facilitates tracking the time and activities associated with chronic care management services for Medicare billing purposes |
Download Format: Excel |
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Community-Based Organization Referral Form |
A template for providing the essential information needed when referring patients to community-based organizations |
Download Format: PDF |
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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 |
Download Format: PDF |
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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 |
Download Format: PDF |
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Dementia Care Plan Checklist |
A tool for developing a care plan for patients with dementia |
Download Format: PDF |
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DME Documentation Templates |
Templates for documenting medical necessity of certain types of durable medical equipment |
Download Format: PDF |
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DME Ordering Templates |
Templates for ordering certain types of durable medical equipment |
Download Format: PDF |
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Emergency Supplies Checklist for Family Medicine Offices |
A list of medical equipment, medications, and other supplies that may be needed during an office emergency |
Download Format: PDF |
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Exercise Diary |
A diary to help patients track their daily exercise |
Download Format: PDF |
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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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Health Confidence Measure |
A tool for assessing patients' confidence in their ability to control and manage their health problems |
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: PDF |
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Initial Transitional Care Contact Form |
A form for documenting the initial contact a practice has with a patient receiving transitional care services |
Download Format: PDF |
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Mock Emergency Evaluation Form |
A form for evaluating your practice's response to a mock emergency situation |
Download Format: PDF |
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Opioid-Associated Emergency for Health Care Workers Algorithm |
An algorithm from the American Heart Association for managing opioid emergencies in the clinic |
Tool as published |
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Patient-Centered Care Plan |
A form designed for use when providing chronic care management services to Medicare patients |
Download Format: PDF |
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Pocket Guide to Patient Communication |
A table of the tips and key phrases physicians can use with patients to improve communication during visits |
Tool as published |
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Preventive Visit Algorithm: Patients Ages 18-64 |
A summary of preventive services suggested for patients ages 18 to 64 years |
Download Format: PDF |
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Previsit Planning Checklist |
A checklist used by the medical assistant to identify potential care gaps and otherwise better prepare for an upcoming patient appointment. |
Download Format: PDF |
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Quality Measures for Primary Care |
This compilation of common quality measures can serve as a checklist for primary care physicians |
Download Format: PDF |
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Refugee Health Checklist |
A checklist summarizing the components practices should have in place when caring for refugees. |
Download Format: PDF |
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Risk-Stratification Algorithm |
A two-step algorithm to determine a patient's risk level |
Download Format: PDF |
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Sleep Diary |
A diary to help patients track their sleep patterns |
Download Format: PDF |
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Standing order for medication refills |
A standing order including the rules for non-physicians to refill patient medication, as an example of standing orders in general. |
Download Format: PDF |
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The "FAVER" Approach: Responding to Inappropriate Patient Requests |
A five-step framework for responding to inappropriate requests from patients |
Download Format: PDF |
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The modern day "black bag" for home visits |
A list of the supplies and other items needed for house calls |
Tool as published |
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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 |
Download Format: PDF |
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Upper Respiratory Tract Infection Telephone Triage Form |
A nurse triage form to prepare for the annual flu season |
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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