FORMS DISCLAIMER:

Gold Star Medical provides these medical administration and documentation forms to assist doctors in understanding common documentation procedures. While Gold Star Medical believes, based upon its research, that these are the most common documents you will need, these documents are not exclusive and may not be all of the documentation you need to substantiate the need for medical necessity of a patient encounter, and/or subsequent insurance claim. It also does not guarantee OIG/HHS/HIPAA/PCI/PQRS compliance. You, the doctor/provider, should inquire with the applicable regulatory agencies, insurance carriers, billing agencies, your state licensing board, your practice consultant, and/or your malpractice carrier to determine if this documentation meets compliance standards and/or additional documentation is necessary. Gold Star Medical does not provide these forms as a substitute for legal or clinical advice.

Please use these documents as illustrative of the components of documentation and not as a replacement for your clinical expertise or decision making. These forms are not intended to replace or direct your clinical expertise or decision making as you provide care to your patients.

FORMS- ADMINISTRATIVE


NEW PATIENT INTAKE FORM

PATIENT UPDATE FORM

OFFICE FINANCIAL POLICY-CHIROPRACTIC

INSURANCE VERIFICATION FORM-GENERAL
INSURANCE VERIFICATION FORM-CHIROPRACTIC
INSURANCE VERIFICATION FORM-BEHAVIORAL HEALTH




FORMS -CLINICAL

CONSULTATION QUESTIONNAIRE-CHIROPRACTIC-PT
RADIOLOGY REPORT -CHIROPRACTIC-PT
PATIENT OUTCOME ASSESSMENT SUBJECTIVE
EXAM FORM - CHIROPRACTIC
TREATMENT PLAN - CHIROPRACTIC-PT