Forms, Templates and Resources


The following forms are researched, flexible, accurate, and easily tailored to your practice needs. KAC members in good standing can download, edit, and continue to utilize these forms and templates for FREE in their offices throughout their membership lives (please see licensing terms and conditions below). Downloading is an easy one-step process – When you select to download a form below, we will take you to your account and automatically download the form.

Click on the form name or the + to expand the category listing. Once expanded, you will find a link to the various forms and templates along with a link to an article that explains how to use the linked form. Jump to your needed category by clicking a category button here:

Good Faith Estimates


ICD-10 Resources
Lien Resources
Medicare Advanced Beneficiary Notice
Form – expires 6.2023 Advance Beneficiary Notice of Noncoverage ABN – English
Form – expires 6.2023 Advance Beneficiary Notice of Noncoverage ABN – Spanish
Resource – expires 6.2023 Form Instructions Advance Beneficiary Notice of Noncoverage


The ABN, Form CMS-R-131, and form instructions are expiring as of June 30, 2023.  The NEW ABN form has been issued by CMS. The use of the renewed form with the expiration date of 01/31/2026 will be mandatory on 6/30/23.


You may continue to use the ABN form with the expiration date of 6/30/23 until the renewed form (expiration date 01/31/2026) becomes mandatory on 6/30/23. However, don’t forget!  If you continue to use the expired version of the form after June 30, 2023, Medicare will deem the form to be defective and may demand that you refund the patient.

06.2023 ABN All Resources for June 2026 ABN form – includes instructions, Spanish and English forms Click here
Anthem Resources
AIM Postpone Indefinitely letter from DOI Click here
Indiana Alpha pre-fix list Click here
Ohio Alpha pre-fix list Click here
2023 Provider Rep list Click here
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Foundation for Chiropractic Progress Resources

F4CP Videos


Download Link
2023 Olivia Athens Chiropractic Video Click here
2023 F4CP Commercial Click here
2023 F4CP Pregnancy Commercial Click here
2020 F4CP Olympic Commercial Click here
Social Media Covers


Download Link
2022 Better Posture Social Media Cover Click here
2022 Drug Free management Click here
2022 Effective Care Click here
2022 Fall Prevention Click here
2022 Family Care Click here
2022 Health Workforce Click here
2022 Low back pain Click here
2022 Military and Vet care Click here
2022 Optimal Performance Click here
2022 Optimized Health Click here
2022 Personal Injury Care Click here
2022 Women’s health Click here
2023 Falls Prevention Click here
2023 Choose Chiropractic Click here
04.2023 Choose Chiropractic Click here
05.2023 Choose Chiropractic Click here
06.2023 Choose chiropractic Click here
07.2023 Choose Chiropractic Click here
08.2023 Choose Chiropractic Click here
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The Kentucky Association of Chiropractors, Inc. (KAC) grants exclusively to KAC members in good standing (“authorized users”) a non-transferable license to use KAC Forms, Templates and Resources above for the purposes set out in the full terms and conditions. Your use of our site and its Forms and Templates constitute your agreement to abide by the Terms of Use and License of KAC Forms, Templates and Resources.

As a reminder, this License terminates for any Kentucky Association of Chiropractors member user at such time as the member is no longer in good standing according to the KAC bylaws. Users who are not in good standing, including without limitation those who are not current in payment of dues, are not authorized to use KAC forms, templates and resources, and any such use is strictly prohibited.