Home Oxygen Therapy

Home Oxygen Therapy

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 home oxygen therapy.

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.

We held Special Open Door Forum calls on October 26, 2016 and January 5, 2017 to get your feedback on the draft versions of the templates and CDEs previously posted. Here you’ll find the most recent versions of the home oxygen therapy templates and/or CDEs. If you require a previous version, please send your request to clinicaltemplates@cms.hhs.gov.

Type of DocumentationDownload
F2F Encounter 
Lab Test Results 
Home Oxygen Therapy OrderCDEs (PDF) Draft R4.2 6/19/2018
 Template (PDF) Draft R4.2 6/19/2018
Home Oxygen Therapy F2F EncounterCDEs (PDF) Draft R4.0 9/5/2017
 Template (PDF) Draft R4.0 9/5/2017
Home Oxygen Therapy Lab Test ResultsCDEs (PDF) Draft R4.0 9/5/2017
 Template (PDF) Draft R4.0 9/5/2017


We want to hear from you! Email us your comments and suggestions about the draft templates and CDEs.


Page Last Modified:
12/13/2023 12:20 PM