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Clinical Template Resources

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  • We welcome your feedback and encourage you to submit questions and comments about your experiences with these clinical templates, or how you think we can improve them!

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We designed these printable clinical templates and suggested clinical data elements (CDEs) to assist providers and IT professionals with data collection and medical record documentation to support coverage of selected items and services. These templates and CDEs are intended to help reduce the risk of claim denials and ensure that medical record documentation is more complete.

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Download Templates and CDEs

See a complete list of templates and CDEs for your reference.

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Share Feedback

We welcome your feedback and suggestions on how to improve all our templates and CDEs and want to hear about your experiences using them.

Providers and IT vendors can choose whether or not to use the printable clinical templates and/or the suggested CDEs.

  • The suggested CDEs aren't a form, but a tool that IT vendors can integrate into electronic health record (EHR) systems to create prompts to assist providers with their medical record documentation for Medicare purposes.
  • The templates and CDEs are intended to be a helpful guide but every section may not apply to all patients’ services and/or Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). Providers can choose the information or CDEs that do apply.
  • Once completed by the physician or other practitioner, the resulting documentation would become part of the medical record.

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