Free Medical Prior Authorization Tracking Log PDF
Track every prior authorization request, status, and decision in one printable PDF log.
Published November 28, 2025
Use this free prior authorization tracking log to organize medication, imaging, and procedure requests, along with insurer decisions and follow-ups.
When to use this
- You need a clear record of each prior authorization request for medications, imaging, or surgeries.
- You’re calling payers repeatedly and want to log reference numbers, decisions, and follow-up dates.
- You’re preparing for an appeal and need a timeline of status updates and outcomes.
How to do it (fast)
- Enter the patient, insurer, and clinic details.
- Add each prior authorization with request dates, service types, CPT codes, statuses, and notes.
- Download the PDF log to share with providers, appeals teams, or legal counsel.
Why this helps
- Keeps medication, imaging, and surgical prior auths together in one place.
- Shows decision dates and authorization numbers for faster follow-ups.
- Provides a printable record to support appeals or urgent escalations.
Related tools
Not legal advice. Courts set their own rules. Keep your original records.