Practice Management Forms Guide Sample

1. X-ray Report Forms: The following x-ray report forms could be utilized as a guide when reading x-rays.
   
   1. Cervical x-ray
   2. Lumbar x-ray
   3. Thoracic x-ray
   4. Shoulder x-ray
   5. Knee x-ray
   6. Extremity Study x-ray


2. New Patient History Forms/Update Form: The following history forms could be utilized for your initial patient consultation/history.
   1. Regular New Patient Health History
   2. Pediatric Health History
   3. Authorization For Care Of A Minor
   4. Personal Injury Health History
   5. Worker's Compensation Health History
   6. Existing Patient Update Health History: This is for existing patients who have not been seen in 6 months or more
   7. Headache History


3. Patient Exam Forms: The following exam forms could be utilized as a guide for doing a thorough physical exam.
   1. Lower Quadrant Exam
   2. Upper Quadrant Exam


4. Reception Room Resumes: The following "reception room resumes"(RRR) serve as examples of what we recommend you provide in your reception room. We also have a sample curriculum vitae.
   1. Dr. Eric Eiselt's RRR
   2. Dr. Mark King's RRR
   3. Dr. Steve King's RRR
   4. Dr. Donna Moloney's RRR
   5. Dr. Jason Placeway's RRR
   6. Dr. Mark King's C.V.
   7. Dr. Steve King's C.V.


5. Financial Policy Forms & Insurance Forms: The following forms can be used for insurance/billing purposes.
   1. Benefits assigned
   2. Care Source (Managed Medicaid) Financial Policy
   3. Insurance tracking form
   4. Insurance financial policy
   5. Insurance verification form
   6. Medicaid financial policy
   7. Medicare financial policy
   8. Special Consideration/financial hardship form
   9. Route Slip Prices
   10. Records Release For
   11. Consent for Purposes of Treatment, Payment and Healthcare Operations
   12. Assignment Of Benefits and Release


6. Practice Management and Promotion guide forms: The following forms serve as a guide regarding standards of practice management and practice promotion.
   1. Ethical and Effective Practice Promotion
   2. Styles of Practice outline/description
   3. Report of Findings outline/guideline


7. Miscellaneous Forms.
   1. Diagnostic Testing Referral form
   2. Informed consent
   3. New Patient Phone Intake form
   4. Stretches for patients to take
   5. New Hire Interview Questionaire


8. Sample exercise sheets.
   1. Advanced Plank Series
   2. Basic Plank Series
   3. Basic Serratusanterior
   4. Boat Pose
   5. Clam 1
   6. Foam Roller Mobilization
   7. Hip Extension Swissball
   8. Intermediate Planks
   9. Low Back Big 3
   10. Modified Dead Bug
   11. One Leg Standing Series
   12. Posture Relief
   13. Prone Arm Extensions on Swiss Ball
   14. Serratus Anterior/Push-up Plus
   15. Short Foot Exercise
   16. Ski Jump Exercise
   17. Triple Loaded Arm Stretch
   18. Wall Angel Exercise
   19. Banded Glute Bridge
   20. Banded Serratus Anterior/Scapular Stabilization Knees
   21. Banded Serratus Anterior/Scapular Stabilization Prone