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 |
|---|---|
| Order | |
| Basic Home Blood Glucose Monitor & Supplies Order | CDEs (PDF) Draft R1.0a 9/5/2017 |
| Template (PDF) Draft R1.0a 9/5/2017 | |
| Specialty Home Blood Glucose Monitor & Supplies Order | CDEs (PDF) Draft R1.0a 9/5/2017 |
| Template (PDF) Draft R1.0a 9/5/2017 | |
| F2F Encounter | |
| Basic Home Blood Glucose Monitor & Supplies F2F Encounter | CDEs (PDF) Draft R1.0a 9/5/2017 |
| Template (PDF) Draft R1.0b 10/31/2017 | |
| Lab Test Results | |
| Basic & Specialty Home Blood Glucose Monitor Lab Test Results | CDEs (PDF) Draft R1.0a 9/5/2017 |
| 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.