New patient referrals to our clients: 814,233 Referrals as of 02/15/2019

Documenting Therapeutic Exercises

This outline of therapeutic exercise verbiage is provided as a BASIC level of therapeutic execise instruction to use when documenting the patient encounter.  If you are including billable therapeutic exercises you MUST include the time the patient started and the time they ended using proper CPT time guidelines.  These MUST be supervised by YOU THE DOCTOR.   The content here represents the bare minimum when documenting the incorporation of active care recommendations into your treatment. This outline is designed to document home care instructions.  If you are trained in a specific technique or rehabilitative procedure, categorize your recommendations into one of the three categories. Moving from range of motion to isotonic exercises is the basic shell of any program. Since many doctors of chiropractic discuss these concepts with patients but do not document them in treatment notes I have posted these here. MDs, carriers and attorneys want to see that you instructed on active care and it was documented rather than multiple pages of canned exercises. This verbiage is basic and is designed to give you a level of documentation that shows you have instructed the patient on self care and are incorporating active therapies into your treatment plan. What you do from there is completely up to you and your office techniques.   If you are documenting "supervised theraputic exercise" that are provided "in office" you will need to fulfill additional CPT documentation requirements.  


EMR Forms and Samples 

It doesn't matter what you call it, there has to be an initial patient report. This is a sample of a report that went out from my office on a referral from a MD. This is a proper initial report that will increase the trust between you and the MD. The re-evaluation (30 days later REGARDLESS of number of visits) is in the same format but you are spending less time with the patient since unless the information has changed, you documented the major E/M categories at the initial visitation. This will correlate with the Reporting to the MD consultation.




CLICK HERE FOR RE-EVALUATION FORM  (Patient Fills Out at Re-evaluation)

Getting Started Forms

This area contains the 3 forms that are necessary to lauch the MD Relationship Program from the front desk.  These forms were outlined in the "Implementing the Program from the Front Desk", which is posted in the Training Modules Section.  




"REFERRAL IN and OUT GRID" - keep track of what YOU are sending OUT and where patients are coming FROM! 

How to Build a Curriculum Vitae

Your curriculum vitae is a critical document in the medical-legal arena and your practice. An accurate document is critical for admissibility and with the right credentials, you will open the door for referrals for the lifetime of your practice. The Academy of Chiropractic has partnered with the US Chiropractic Directory to help you create your CV. The US Chiropractic Directory has create the first ever CV builder for chiropractors and it is free for you. Without an admissible CV and relevant credentials to personal injury, lawyers will NOT work with you. STEP 1: Download the "Guide" below to understand the 5 W's (who, what, where, when and why) of CV building. Get the Guide for Creating a Curriculum Vitae by clicking here. STEP 2: Click on the link bleow to go to the US Chiropractic Directory and build your CV. I also urge you to sign up for the a "Preferred Listing" in the Directory. It is $22 and you will be exposing your practice to 10,000's of people per day. Go to the US Chiropractic Directory by Clicking Here and once on the site, go to "Doctors register your practice" on the left side.

Records Release Template

This template was formulated by a Personal Injury attorney in New York State to ensure my office was compliant with Records Requests.  It is mandatory that you have an attorney in your state review this information prior to use to ensure you are compliant. 

 To download the Records Request Template

Click Here


MD Lecture Program

The “Clinical Application of Advanced Imaging” presentation will be receiving approval from the University of Buffalo School of Medicine and Biomedical Sciences to offer Category I AMA credits to medical professionals in the next few weeks.  This email is going out to a select few doctors ahead of the pack and is based on your current knowledge base and your clinical skills. 

This process will “Credential” you as a CME presenter for the Academy of Chiropractic.  This is a CV entry and a HUGE credential to have, not to mention the ability to provide this presentation for CME to MDs, NP, PA in outpatient offices, surgical centers, ERs and specialty medical groups.  I am scheduled to present these in several medical offices to “train” their PA and NP in the western new York area.

This opportunity is restricted geographically because we don’t want doctors stepping over each other.  If you are interested, please email me and I will send you the credentialing sheet and the requirements to get started.  I will work with you personally to help you sent up seminars and teach you how to get through to the MD offices. Right now you must be a member of either the MD Relationship Program or the Lawyers PI program.

Help us launch chiropractic into the medical community by being credentialed to lecture to medical professionals!

To download the Application Click Here

To download the Training Video Click Here

S.O.A.P. Note


With great thanks to our many members nationwide who graciously submitted their S.O.AP. note to create the "best of," I have compiled a single page S.O.A.P. note that is very thorough and designed to take no more then a few seconds in order to create "great paper documentation." This document is included in your service and suggestions to make it better are welcomed.

To download the S.O.A.P. Note Template Click Here



Many states mandate that you have your patients sign an informed consent prior to rendering care. Most insurance carriers also require this. I am not a lawyer and my formal disclaimer is that I am not rendering legal advice; you should confer with legal counsel as to the exact language for your practice. However, the form attached is the "best-of-the-best" from around the country sent by doctors that conferred with both lawyers and insurance carriers.

To download the Informed Consent Template Click Here


HIPAA Patient Privacy Statement

It is federal law to have all patients sign a HIPAA privacy policy about how you handle their protected health information. Please save these documents in your patients' files, as if challenged, you will need to produce them.   

To download the HIPAA Privacy Statement Click Here

Evaluation & Management Coding Guidelines

E & M CPT codes have very specific guidelines. This document synopsizes the parameters that you must follow in order to be compliant. Be very careful, as not meeting the criteria for these guidelines can be construed as an attempt to defraud the carriers and can be extremely troublesome in a retrospective audit. The solution is to do it right from the start.

To download the E & M Coding Guidelines Click Here   

Language for Ordering Testing

(When clinically applicable)

In response to today’s verification requirements with insurers and licensure Boards, it is recommended that the clinical rationale be articulated in every report when a diagnostic test is ordered. The following is suggested language and needs to be customized to your patient’s clinical presentation.

To download Langage for Ordering Testing Click Here


Comprehensive Evaluation Form

This template was designed over a 3 year period and includes every body part and function for all patients, with the personal injury and workers compensation patients in mind. It includes normal's in range of motion of every joint in the body, motor, sensory, and orthopedic tests and has "built in" areas for determining necessity for testing to ensure payment. It is extremely thorough and designed to "walk the doctor through" the evaluation process in the shortest time possible without compromising clinical accuracy. This document was also designed to be forwarded to attorneys and MDs without being typed, with the understanding that an evaluation is not a substitute for a narrative.

To download the Comprehensive Evaluation Form Click Here


Initial Report Dictation Template

Download this form and use it as a template when dictating.  The information that you are dictating is actually from the Comprehensive Evaluation Form, but this template will assist you in making sure you put everything in the proper order.  It works best if you put a copy into a "dictation" binder inside clear sleeves.  You stack the charts you need to dictate, open the dictation template and start dictating.  Very simple and quick.  Most doctors get to a point where they no longer need this, but it is extremely useful when you are starting out.

To download the Initial Dictation Template Click Here


Sample Initial Report - After Dictation 

Here is a sample intial report on a WC case.  This was a pretty straight forward case and this correlates with the Audio Sample in the Audio Section of the site.  Please call or email if you have any questions. 

To download the Sample Initial Report Click Here


Educational Binder

This the cover of the research binders that we send to the MD offices.  Inside will be the MD Bimonthly flier, the patient bimonthly flier and your CV.  You MUST remind the staff at each office visit to place the new fliers into the binder that was given to the MD.  They will forget and the flier will get lost.  When you meet with the MD and/or the mid-level providers, please ask them if they saw the binder!

To download an editable Binder Cover to personalize Click Here

To download a list of Binder Contents Click Here  

Sample Re-Evaluation (Interim) Report Template 

Here is a sample re-evaluation or Interim report template. Please call or email if you have any questions. 

To download the Sample Initial Report Click Here



One of the most important part of the "Getting paid" process is to code correctly. Doctors have somewhere between zero and "0" training in coding and do not understand things such as relative weights, E-codes and DRG's. These issues are critical in the coding and reimbursement process and are used both for and against you in determining reimbursement by third party payors.

We created a diagnosis form for you to use a few years ago and after months of research, have updated the form for you to implement into your practice taking into account all of the issues you need to maximize fair reimbursement for the care of your patients. The form is designed to simply copy and insert in your evaluation without having to figure out what to do or choose beyond correlate the diagnosis to your clinical findings.

This form will be updated to include ICD-10.  

Click here to download the Diagnosis Template




This information is for the MD Relationship Program members ONLY. It is not to be shared, e-mailed, copied or mailed to any other party without express written permission from the MD Relationship Program. The information contained below is governed by US copyright law and intellectual property rights and privileges. If you are receiving this information and are not part of the MD Relationship Program, you are receiving this in an unlawful manner and may be subject to legal ramifications.

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PLEASE TAKE NOTICE: © Copyright CMCS Management, Inc - Dr. Mark Studin 2015 - This information is intended for educational purposes only. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon is prohibited.