Home Blood Glucose Monitors
You can use the printable clinical templates and suggested clinical data elements (CDEs) for the order, face-to-face encounter, and lab test results to assist with documenting your medical records to support the need for basic and specialty home blood glucose monitors and supplies.
Health IT Vendors: To use the suggested CDEs, download or print and use as guidance in creating or enhancing existing electronic clinical templates within your electronic health record (EHR) system.
Providers: To use a printable clinical template, download and/or print the template, complete as applicable and file in the patient’s medical record.
Type of Documentation |
Download |
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Order |
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Basic Home Blood Glucose Monitor & Supplies Order |
CDEs (PDF) Draft R1.0a 9/5/2017 |
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Template (PDF) Draft R1.0a 9/5/2017 |
Specialty Home Blood Glucose Monitor & Supplies Order |
CDEs (PDF) Draft R1.0a 9/5/2017 |
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Template (PDF) Draft R1.0a 9/5/2017 |
F2F Encounter |
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Basic Home Blood Glucose Monitor & Supplies F2F Encounter |
CDEs (PDF) Draft R1.0a 9/5/2017 |
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Template (PDF) Draft R1.0b 10/31/2017 |
Lab Test Results |
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Basic & Specialty Home Blood Glucose Monitor Lab Test Results |
CDEs (PDF) Draft R1.0a 9/5/2017 |
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Template (PDF) Draft R1.0a 9/5/2017 |
We want to hear from you! Email us your comments and suggestions about the draft templates and CDEs.