Documentation Templates

Documentation and Templates

Documentation must include a start time and end time of services provided, a description of the professional services rendered and information regarding the source of the licensed healthcare provider recommendation* for services. Documentation must be kept in accordance with the record keeping requirements of the Medicaid program as outlined in Section 14 - Record Keeping, of the General Information for Providers chapter of the Medicaid Provider Manual and may be subject to review and post-payment audit.

*The State of Michigan’s Chief Medical Executive issued a statewide standing recommendation for doula services which meets the Medicaid program’s requirement that doula services must be recommended by a licensed healthcare provider. No additional service recommendations are required by the Medicaid program.

The following documentation templates are provided as an optional resource only and are not a Medicaid requirement:

• Prenatal Documentation Template
• Birth Documentation Template
• Postpartum Documentation Template