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Centers for Medicare & Medicaid Services

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DMEPOS Templates

DMEPOS Templates

  • Home Blood Glucose Monitor
  • Home Oxygen Therapy
  • Positive Airway Pressure Devices
  • Ventilators
  • Respiratory Assist Devices
  • External Infusion Pumps
  • Nebulizers
  • Immunosuppressive Drugs
  • Enteral Nutritional Therapy
  • Parenteral Nutritional Therapy
  • Therapeutic Shoes for Persons with Diabetes
  • Lower Limb Prosthesis
  • Power Mobility Device

Templates and Suggested Clinical Data Elements (CDEs) for Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS)

You can use the printable clinical templates or suggested CDEs to assist with documenting the following for certain DMEPOS items:

  • Face-to-Face (F2F) Encounters
  • Detailed Written Orders (DWOs) or Written Orders Prior to Delivery (WOPDs)
  • Laboratory Test Results

See a complete list of all clinical templates available for download here.

Page Last Modified:
12/01/2021 05:40 PM
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