The SOPs a new functional medicine practice needs first

A lot of functional medicine practices launch with the workflow stored in one person's memory. Then a lab kit sits in transit, a result arrives on Friday, a contractor starts Monday, and the system turns out to be an inbox search. A standard operating procedure is how the practice keeps behaving like itself when you are in a visit or finally hiring. These are internal instructions. They are not medical orders and they are not legal advice. Have the clinician responsible for the practice review the clinical steps, and check anything that touches consent, fees, or privacy, before you treat a draft as the way you work.

Write the smallest set that covers month one

You can see patients with nothing written down. You cannot train anyone, take a real week off, or answer "what happens after the draw?" the same way twice. In a cash-pay practice the patient is also a buyer. Inconsistent follow-up reads as a sloppy business even when the visit was careful. A written step is also how you notice that a tool is holding health information it should not. If the page says "email the lab PDF from Gmail," you have documented a problem you can fix before it is a habit.

Five workflows plus a short stack of emails will do more than a binder you never open. Each one should fit on a page or two.

New-patient onboarding. Start when someone asks to be seen, not when the visit starts. Where does the inquiry land? Who checks location against your license? What are the fee and the financial policy? How does someone receive a good-faith estimate if they ask? How do booking, intake, and consent happen inside the record system rather than on the marketing site? End at a clear point: the visit is on the calendar, the forms that belong in the record are done, and the person knows how to reach you for logistics without texting a chart. If you have not separated a yes-list of states from a no-list, this procedure has nowhere honest to send people. That check is in practice authority, explained.

Lab ordering and follow-up. Write who may order, which account is used, how the patient is told where to go or that a kit is coming, and what "we are waiting" looks like in the record. Then write the clock. How many days until someone looks for a missing result? Who tells the patient it is back, and through which channel? What has the clinician defined as urgent, and what is the after-hours rule? Results that contain health information do not belong in ordinary email. Name the system that is allowed to carry them.

The first visit. A new 60-minute visit has a before, a during, and an after. Before: what must already be in the chart, and what you do if it is missing. During: the sequence you actually follow, including documentation while the memory is fresh. After: the summary the patient receives, the orders placed, the next appointment if there is one, and the fee that was supposed to be collected. If a request is outside what you do, the page should say where it goes. A template cannot make that decision for a patient you have not met.

Follow-up, even a short version. Stop treating every return visit as a novel. What gets reviewed, how far ahead the chart is prepped, how labs since last time are pulled in, and how the plan is written so a later reader can see what was decided. If you sell a package, say which visit in the package this is, so the front desk and the chart agree.

The emails people actually receive. Four cover the early practice: welcome and booking, lab reminders, a note when someone goes quiet, and a review request. Label each as care-related or marketing. Marketing email needs a working opt-out. A review request should not offer a reward for leaving a review, and a public reply should never confirm that the reviewer is a patient. Read the drafts out loud. If a sentence promises a clinical result, cut it.

Two companions sit beside the procedures. A financial policy: fees, no-shows, refunds, and how a self-pay patient asks for an estimate. And one emergency line for anyone who answers the phone or the portal: this practice is not an emergency service, and someone in immediate danger should call emergency services. Write it down before a new contractor tries to be helpful.

A shape someone else can run

Use the same headings every time.

• Trigger. The form, the result, or the date that starts the work.
• Owner. One role. Name it even when you are solo, so hiring does not require a rewrite.
• Steps. Numbered verbs. "Check location against the yes-list" is a step. "Provide a great experience" is not.
• Tool. Where the work happens, and where it must not. If health information is involved, the tool needs a business associate agreement that covers that feature.
• Done. The sentence that closes the task. Result filed, patient notified in the portal, follow-up offered or declined.
• Exceptions. The two or three ways it goes sideways: a missing kit, a patient in the wrong state, a result your clinician has defined as urgent.

Train with fictional patients and obviously fake data. A screenshot of a real chart does not belong in a folder your web designer can open. Revise the page when something breaks, not on a vague annual cycle. If a vendor changes its portal, the procedure changes the same week. If a new hire marks a confusing step, that markup is the revision.

Do not automate a process you have not run

It is tempting to jump from "write this down" to "software should do it." A written page is what you would later hand to a person or, much later, to an automated front desk. Automating a process you have not run by hand hides the missing step, and it raises a privacy question the moment the software can see a chart. That kind of tool needs agreements with your practice and with its own vendors, a clear statement that the person is talking to software, and a hard stop that sends emergencies to emergency services. You do not need it to open. You need the one-page procedure.

The same restraint applies to supplement protocols and condition-specific marketing pages. Those need clinical sign-off and a claims review. They are a poor first procedure because they are the easiest place to overclaim. Get onboarding, labs, the first visit, and the emails working on fake data. Then widen the folder.

Keep the state checklist in the same folder, dated: license, practice-authority category, transition hours, prescriptive authority, and the patient-location question. The wider launch order is in how to start a cash-pay telehealth practice.

The Functional Practice Playbook is the drafted version of this folder — procedures, emails, website blueprint, blog calendar, and pricing worksheets — marked for your own review. It is not a set of approved legal documents. The current price is on the pricing section.