Primary Care — Telehealth Visit Template

The Telehealth Visit Template is designed for primary care providers conducting virtual visits via video or telephone. This template addresses the unique documentation requirements for telemedicine encounters including technology platform used, patient location, verification of patient identity, assessment of appropriateness for telehealth, focused history and examination adapted for remote assessment, and treatment plan with appropriate follow-up. The template ensures compliance with telehealth billing requirements (CPT 99211-99215 with modifier 95 or GQ) and documents the unique aspects of remote care delivery. Key sections include visit type (video vs. telephone), patient location and technology verification, focused history adapted for remote assessment, visual examination findings when possible via video, assessment of appropriateness for telehealth vs. in-person evaluation, treatment plan with prescriptions sent electronically, patient education on self-monitoring and warning signs, and clear instructions for when in-person evaluation is needed. This template supports the growing demand for telehealth services while maintaining quality documentation standards. Ideal for primary care practices offering telehealth options, rural practices serving remote patients, and practices managing patients with mobility limitations or transportation barriers.