©2024 by the American Board for Certification in Orthotics, Prosthetics & Pedorthics, Inc. All rights reserved.
No part of this document may be produced in any form without written permission of the American Board for Certification in Orthotics, Prosthetics & Pedorthics, Inc.
October 2023
The online Resource Pack is your go-to source for sample forms, templates, checklists and articles available for you to review, use and modify to fit your practice’s needs. You can access the Resource Pack from your facility’s MY ABC account.
Annual Facility Review Checklist *UPDATED
OIG Exclusion Checklist (AD.5.1)
Patient Acknowledgement Form
Employee Verification (HR.2, 4.1 and 4.2)
Instructions for Establishing Privileging Criteria (HR.6 and 6.1) *UPDATED
Individual Privileging Record Template (HR.6 and 6.1)
Employee Performance Evaluation Form (HR.7)
Assessment of Employee Continued Competency (HR.7)
Equipment Maintenance Log (PS.3.1 and PS.12) *UPDATED
Free Sample Patient Satisfaction Survey (PM.2)
How to Write and Analyze Customer Satisfaction Surveys (PM.2.1)
Guide to Patient Satisfaction Trends
Billing and Coding Error Report (PM.6)
Safety Management Checklist (FS.1.1) *NEW for 2019
Fire Emergency Drill Documentation (FS.3.2.1 and 3.2.2)
Disaster Preparedness Resources (FS.3.3) *NEW for 2019
Billing Education Documentation (CB.3)
Patient Chart Audit Form (CB.4 and 4.1)
Patient Care Communication Log
Medicare Patient Phone Surveys
Medicare Complaint Form
CAP FAQ Flyer
Sample Referral Thank You Card *NEW for 2019
Sample Accreditation Press Release