Patient Management Program - HCAI
Tracking Sheets
These forms have been designed to assist with tracking the office visits for your Motor Vehicle Accident
patients. Full page copies can be found at the end of this guide. An electronic copy is available by
contacting support.
MIG Tracking Sheet. Record the initial visit date
and the date range for blocks when your patient
begins care. This form should be attached to the
front of the patient file or attached to the travel
card so you have it readily available. Fill in the
boxes with the actual dates of treatment as your
patient attends their office visits. As you complete
the form, you can tell at a glance the status of the
MIG.
The Treatment Plan Tracking Form will help you to
recognize at a glance when it is time to submit new
treatment plans for MVA patients who do not
qualify for pre-approved framework.
Mark the tracking form to indicate the number of
treatments covered by your Treatment Plan by
highlighting the correct number of boxes or by
putting brackets around them. When your patient
attends their office visits, record the actual dates
of treatment in the boxes. If you are treating your
patient twice a week and know it will take two
weeks to get approval for a new Treatment Plan,
you need to submit an extension request when the
patient has six visits left.
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