You can use the printable clinical templates and suggested clinical data elements (CDEs) for the order, progress note, and certification statement to assist with documenting your medical records to support the need for Therapeutic Shoes for Persons with Diabetes.
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 | |
| Therapeutic Shoes for Persons with Diabetes Order | CDEs (PDF) Draft R1.0a 6/08/2018 |
| Template (PDF) Draft R1.0a 6/08/2018 | |
| Progress Note | |
| Therapeutic Shoes for Persons with Diabetes Progress Note | CDEs (PDF) Draft R1.0a 6/08/2018 |
| Template (PDF) Draft R1.0a 6/08/2018 | |
| Certification Statement | |
| Therapeutic Shoes for Persons with Diabetes Certification Statement | CDEs (PDF) Draft R1.0a 6/08/2018 |
| Template (PDF) Draft R1.0a 6/08/2018 | |
| Appendices | |
| Therapeutic Shoes for Persons with Diabetes Appendices | Appendices (PDF) Draft R1.0a 6/08/2018 |
We want to hear from you! Email us your comments and suggestions about the draft templates and CDEs.