Check Medicare Claims Processing Manual, 100-4, Chapter 18, section 180.1 for the ETOH screening information. The five A's are:
These are discussed in detail. I have seen no specific template, but you can devise one based on these items and the expectations outlined.
The attachment to this chapter, Transmittal 2358 also discusses this information.
There's a MedLearn Matters article for CVD. The 5 A's are the same, just related to CVD. Look at MM7636.
Hope this helps. Pam
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