Medical Loss Prevention Resources

Increasing complexity of the medical practice, rapid changes in healthcare and shortage of time and resources are serious challenges faced by healthcare professionals. CMIC | Group has created resources to aid doctors and practice administrators in the daily management of medical practices and patient relationships. As a CMIC | Group member you can log in to our resource area to view these resources.  In addition, loss prevention specialists are readily available to answer your questions via phone or email.

  • Against Medical Advice Discharge Policy
  • Agreement to Comply with Practice Expectations
  • APRN Collaborative Agreement
  • Business Associate Agreement Template
  • Consent for Treating Minors
  • Consent Form - Off Label Use of FDA Approved Drug
  • Consent to Leave Phone Messages/Release of Information
  • Consent to Online Communication
  • Controlled Substance Agreement and Informed Consent Form Template
  • Diagnostic Testing, Referral and Procedure Tracking Log
  • Disclosure and Apology Policy
  • Dispensing Form
  • Financial Policy Template
  • HIPAA Authorization Form
  • HIPAA Medical Record Release Template
  • HIPAA Privacy and Security Policy Incident Report
  • Hospital Policy - Investigation of Medical Technology Related Events
  • Informed Consent Policy
  • Language Access Plan and Protocol Template
  • Medication Sample Tracking Log
  • Medication Self Administration Evaluation Form
  • Missed Appointment Communication Template
  • Newspaper Ad when Discontinuing your Medical Practice
  • No-Show Policy and Correspondence Template
  • Notice of Privacy Practices Template
  • Notice to Patients when Discontinuing your Medical Practice
  • Opioid Resources
  • PA Collaborative Agreement
  • Parental Authorization Form
  • Patient Complaints Policy
  • Patient Survey
  • Pre-Operative Medication Instructions
  • Refusal of Recommended Medical or Surgical Treatment
  • Sleep Safety for Infants and Toddlers Policy
  • Telemedicine Consent Form
  • Terminating the Physician-Patient Relationship


If you have questions about our loss prevention services, please contact our Director of Loss Prevention using the contact information below:

Email - Denise Condron

Phone - 800.228.0287 x256



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