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Encounter Forms / Superbills


Contents on these pages can be viewed by hovering over the icon to the left of the links with your mouse. They can also be printed.

They can also be seen and/or downloaded directly, by right-clicking on the link with your mouse and opening to a new window.

Anesthesia Charge Sheet - from Eileen Lorenco, in Excel format.

Cardiology Encounter Form Template

Family Practice Encounter Forms  from  the AAFP

American Academy of Family Practice  

Maternal-Fetal Services Encounter Form Sample  (outpatient clinic-based) 2007 - from Society of Maternal Fetal Medicine

Orthopedic Charge Sheet (aka: Superbill) - from DPM in GA. This is in XLS format and can be modified. (as of 4/18/209 - this link is now working! SORRY)

Physical Exam Encounter Form- with 1995 E/M Guidelines from ACOG

Physical Exam Encounter Form - Physical Exam Encounter Form Template with 1997 E/M Guidelines from ACOG

TEE Report (Intraoperative)- Blank template for a transesophageal echocardiogram (TEE) Report from Society of Cardiovascular Anesthesiologists

TEE Report (Intra / PeriOperative) - Blank Sample Template from the American Society of Anesthesiologists    

Trigger Point Encounter Form- Trigger Point Injection Form In Word from Ace Anesthesia