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Free Telehealth Visit Log PDF for Disability & Insurance

Download a free telehealth visit log PDF to organize virtual doctor visits for disability claims, insurance appeals, or FMLA paperwork.

Published November 30, 2025

Keep a clear record of virtual visits so you can show what was discussed, diagnoses, medication changes, and follow-up plans.

When to use this

  • You’re preparing an SSDI/SSDI appeal or short-term disability claim and need to show ongoing treatment.
  • An insurance denial appeal or FMLA request requires detailed visit notes.
  • You want to track telehealth visits across multiple providers or platforms in one place.

How to do it (fast)

  1. Open the telehealth visit log tool below.
  2. Enter your name, date range, and what you’re using the log for (SSDI, FMLA, insurance appeal).
  3. Add each visit with the provider, specialty, platform, purpose, diagnoses, medication changes, and follow-up plans.
  4. Download the PDF and attach it to your appeal, HR paperwork, or insurance submission.

Why this helps

  • Shows consistent care and follow-up for disability claims or appeals.
  • Keeps provider details, diagnoses, and medication changes together for quick reference.
  • Provides a clean exhibit you can attach to HR, insurers, or legal filings.

Related tools

Not legal advice. Courts set their own rules. Keep your original records.

What to record for each visit

Include the date, provider name, specialty, platform (Zoom, portal, phone), why you were seen, any diagnoses, and medication changes. Add follow-up plans like labs or imaging so you can prove ongoing treatment.

Why logs matter for SSDI, disability, and insurance

Disability claims and insurance appeals often hinge on showing consistent care. A dated log ties together what was discussed, changes to treatment, and next steps, making it easier for reviewers to see your compliance.

How to export and attach as an exhibit

After you add your visits, download the PDF and include it with your HR paperwork, appeal letter, or evidence packet. Keeping everything in a single PDF avoids digging through portal messages when deadlines are tight.

How to use the tool

  1. Open the telehealth visit log tool below.
  2. Enter your patient name, date range, and intended use (disability, insurance, or FMLA).
  3. Log each visit with provider details, diagnoses, and follow-up plans.
  4. Download the PDF to attach as an exhibit or HR document.

Open the telehealth visit log tool

Track virtual visits and export them as a PDF exhibit.

Open the Telehealth Visit Log tool

Last updated November 30, 2025