Templates

Detailed Summary of Interactions

Communication Log

Previous Treatment and Medications Tried

Appeal Attachments

What Medical Necessity Means - and How to Prove It

Template: Letter of Medical Necessity

Template: ALJ Hearing Personal Statement

Template: Patient Appeal Letter

Template: Phone/Chat Scripts - Prior Authorization or Denials

Template: Complaint Letter to Regulator

Quick Reference: My EOB Code Tracker 

Most Common EOB Codes and What They Mean

Caregiver Advocacy Toolkit

Medication List Template

Diagnosis List Template

Provider Contact List Template

Pain Management - Pain Tracker

Compare Insurance Plans - Open Enrollment

Daily Symptom Log 

Weekly Symptom Log

Flare-up Tracker

Formal Complaint Regarding [Physician’s Name, M.D./D.O.] – Failure to Provide Adequate Pain Management and Potential Patient Neglect

Sample Complaint Letter to State Medical Board 

(Filed by Caregiver or Advocate) 

Where to File Complaints to the State Medical Boards

Medication and Side Effects Log

Caregiver Authorization Tracker - 

Tracking Release of Information (ROI) and Authorizations

Caregiver Role Clarity Worksheet

Contact List - Advocate Communication Log

Call Log Template Guide for Caregivers

Call Log Template for Caregivers