If you're working at nursing homes or other non-office locations, you probably want to know how to:
  • Generate better-detailed charts that firmly support your billing.
  • Protect yourself from audits by Medicare, and from claims of fraud and abuse.
  • Reduce your time spent on documentation.
  • Minimize your cost of documentation.
  • Feel secure about compliance with the latest documentation requirements.
  • Be recognized for all the services you provide and actually get paid for them.

    This form is here to help. It has everything you need to effectively document and bill nursing home, hospital and home visits.


  • Two-part NCR carbonless duplicate exam form. No need to make photocopies of your notes or charts. (You should always keep a copy of all notes and charts for your records. This form makes that easy.)
  • An exam that follows the latest published guidelines from Medicare HCFA/AMA for medical documentation.
  • An Exam that guides you, the doctor, to supply the required information in the format Medicare expects.
  • Detailed orders to nursing staff that you customize with minimal writing.
  • A Podiatric Superbill / Fee / Routing slip with appropriate codes and modifiers for billing Medicare for home services.
  • By minimizing the steps involved in processing, filing and billing, the form facilitates same-day completion of chart documentation and billing.
  • Eliminates the high cost, extra time and risk associated with handwritten, dictated or cookie-cutter computer generated notes.

    These highly efficient forms allow podiatrists to complete their exam and treatment plan documentation, plus do their billing before leaving the nursing / hospital facility.

    With the POD-4030 it’s likely that you’ll never again leave out any of the information that's required to pass an audit.

    Complete Documentation in Four Easy Steps

    Using the POD-4030 forms in the nursing home setting, you can entirely complete your documentation and billing at the nursing station immediately after your patient encounters. Here’s the sequence:
    1. Complete the exam documentation, sign and date the exam and then pull the forms apart, removing the copies marked ORIGINAL PATIENT CHART. These will be placed in the patients’ facility charts.
    2. Once the Original Patient Chart is separated from the rest of the form the DOCTOR’S COPY of the Original Patient Chart and the routing slip are exposed. Note your diagnoses, E&M(s), and/or the procedures you performed on the routing slip,.
    3. You or your assistants then collect and record any of the patient data necessary for billing or updating your office records.
    4. Back at the office turn the Doctor’s Copy of the exam and the routing slip over to the staff for billing and filing in the parallel office chart you keep for each patient.

    For large and small providers alike, the POD-4030 nursing home forms have proven to be the most time-efficient and cost effective means to create and maintain Medicare-acceptable documentation. The MDS data, clarity and consistency of the form make it (and the doctors who use them) the preferred choice of nursing facilities across the country. (See the sidebar to the right, above.) Most importantly, they afford doctors the peace of mind of knowing they are prepared for the inevitable audits and close scrutiny that comes with providing nursing home care.

    Unique design:

    The DocuForms Nursing Home report has a unique structure. It takes a few seconds to understand, but its convenience will save you a great deal of time over the years.

    1. There are five layers (pages) in the form, attached by tabs at the top and the bottom.

    Page 1 (front of top layer)
    Page 5 (back of bottom layer)

    2. The front of the top layer (page 1) and the back of the bottom layer (page 5) are the two pages of the original exam form. These are the layers on which you record the exam.

    Page 1, with page 2 yellow carbonless copy revealed below

    Page 5, with page 4 yellow carbonless copy revealed below

    3. Both of these layers create a carbonless copy on the sheet directly below it. (Page 2 contains the copy of page 1, and page 4 contains the copy of page 5.)

    Middle Layer (front of Routing Slip)
    Middle Layer
    (back of Routing Slip)

    4. The middle layer (page 3) contains a Routing Slip.

    The exam form pages are easy to fill out during the exam (or right after it). The originals, (pages 1 & 5) stay at the nursing facility (to be placed in the patient’s chart), while the duplicates (pages 2 & 4) are for the doctor’s records, as is the Routing Slip.

    How to separate pages 1 & 5 (the originals) from the other pages:

    1. Bend the tab at the top of the form back and forth a few times, along the perforation.

    Top tab
    Bottom tab

    2. Grasp the tab at the top of the form between the thumb and forefinger of one hand, and the tab at the bottom of the form between the thumb and the forefinger of the other hand.

    3. When you pull these tabs apart pages 1 & 5 will separate from the other pages.


    With the addition of MDS data, the POD-4030 has become the preferred method of chart documentation for many nursing homes. Podiatrists who use the 4030 get a real competitive advantage over those who submit traditional documentation.

    About MDS: Nursing homes are required to report to Medicare and state regulatory authorities, as often as weekly, a complex and lengthy structured patient assessment. This data, called the Minimum Data Set, is used in part to determine the variable level of reimbursement which the nursing home will receive for the patient’s care, and monitor that the patient is receiving the necessary ongoing care.

    The MDS Data is gathered from the patient’s chart by a specially trained nurse, often called the MDS Coordinator. The MDS Coordinator must carefully read (and understand) all the doctors, nursing, therapy and dietary, etc., notes looking for MDS data. The Coordinator must then appropriately transfer the information onto a lengthy, complicated multipage MDS survey form.

    Several large nursing home chains who have used our POD-4030 forms for years found that they were doing a better job in collecting the MDS from our forms because of their complete, legible and consistent structure. However, they felt they could do an even better, quicker job if we could highlight the MDS items in yellow and provide cross-reference indications for them.

    Starting with the 2000 version of the form, we highlighted areas pertinent to the current MDS and referenced the sections accordingly. The response from the nursing homes has been enthusiastic. They report that they are collecting and reporting better, more complete (accurate) information in less time at a lower staff cost. Best of all they are receiving appropriate levels of reimbursement and they are better prepared for their audits.

    TIP: Grow your nursing home practice. Target the facilities you would like to serve. Schedule an appointment with the DON and MDS Coordinator, show them the MDS-compatible POD-4030 documentation you can provide them with and explain the lower extremity care you can offer their residents. Bring your instruments – they may ask you to start immediately!