Narrative for Phlebotomy

A narrative template for claims that include platelet-rich plasma or platelet-rich fibrin. It has blanks for the date, patient name, member ID, date of birth, and the recommending doctor, and explains that PRP or PRF comes from the patient’s own blood and contains growth factors. A marked space is left for the patient’s specific information, and the closing confirms that the patient was informed and consented.

Use it when the office bills for PRP or PRF with a surgical procedure. The insurance coordinator fills in the marked section from the patient’s records, has the doctor review it, and sends it with the claim. Keep a completed copy in the chart in case the payer asks for more information.