Outpatient Encounter Form

Outpatient encounter form is a template that is specially formulated and designed for the use during charge capture process of a medical office. This form is mainly divided into four different parts including information about patient, services, modifiers and summary. Complete information about the patient is recorded in this form including patient ID number, patient name, and address of patient, city or state, social security number, date of birth, age and contact number. Payment method is also listed in detail including primary ID number, primary group number secondary ID number, secondary group number, cash/credit card or other billing. Detail visit information is also mentioned in this form including the date of visit, visit number, rendering physician, referring physician and reason for visit.

The basic objective of outpatient encounter form is to compare the physician’s and patient’s visit related satisfaction in an outpatient setting and to briefly explain the views of these concerned. The patient may be there for an outpatient therapy, outpatient surgery or outpatient treatment.  The other details of outpatient encounter form include the details about the timing and duration of office visits and the category of medical issues for which visit was made. The general symptoms and measures and calculations of the patients are also recorded in this form. These readings include blood pressure, pulse, temperature, height and weight. Other visit information like lab work to user, referral tax, provider signature and next appointment are also mentioned in this form. All details about fee structure including total charges, other payment and total are also part of this form. In short if this form is carefully studies, a lot of improvement can be brought into medical care.


Outpatient encounter form

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