MANAGEMENT PLAN TEMPLATE

MANAGEMENT PLAN TEMPLATE

Management Plan Template– must include these headings

Primary Diagnosis with ICD-10 code, rationale and resources. Include CPT codes, and any procedural codes, including nurse lab draws, vaccinations given, biopsies, etc…10 pts.

Guidelines used to develop this primary diagnosis. 5 pts

Differential diagnoses with rationale and resources. 3-5 Ddx required, unless well visit. 5 pts

Medications including OTC, dosage and education, additional ancillary tests needed, referrals and follow up – 10 pts

Problem Statement – 5 pts

Social Determinants of Health to consider, Health Promotion and Pt risk factors – 5 pts

Must use 3 scholarly references Worth 40 points