FPM Toolbox
Encounter Forms
Download encounter forms to help ensure accurate documentation for asthma, diabetes, hypertension, and other conditions common in primary care.
Acute Knee Injury Encounter Form |
An evidence-based encounter form for evaluating acute knee injury |
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Acute Otitis Media Encounter Form |
An evidence-based encounter form for evaluating acute otitis media |
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Asthma Encounter Form |
A documentation form to identify important elements of care that are recommended for asthma visits |
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Asthma Management Flow Sheet |
A form for tracking key asthma indicators over several visits |
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Cognitive Impairment Visit Template |
A template to guide physicians in determining a patient's level of cognitive impairment |
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Diabetes Encounter Form |
An encounter form for use in documenting diabetes-related visits and ensuring that key issues are not overlooked during the visit |
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Diabetes Encounter Form (Group Visits) |
An encounter form designed to enable physicians to complete much of their documentation prior to a diabetes group visit |
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Diabetes Flow Sheet |
A flow sheet for recording patients’ essential diabetes measures, such as A1c rates, over time |
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E/M Visit Encounter Form |
A encounter form for E/M visits that includes a checklist to facilitate counting history and exam elements for accurate coding selection |
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Emergency Nursing Record |
A form for recording the details of an office-based emergency |
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Group Visit Encounter Form (Nursing Home) |
An encounter form for documenting the history of present illness and physical exams at nursing-home group visits |
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House Call Encounter Form (Medicare) |
An encounter form that guides physicians through the necessary home assessment, encourages accurate coding and helps document the necessity of the home visit |
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Hypertension Encounter Form |
An evidence-based encounter form for evaluating hypertension |
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Medicare Initial Preventive Physical Examination Encounter Form ("Welcome to Medicare Physical") |
An encounter form to ensure all elements of the initial preventive physical exam ("Welcome to Medicare Physical") are completed |
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Medicare Preventive Physical Exam Encounter Form |
An encounter form that details the components required for the "Welcome to Medicare Physical," the initial annual wellness Visit, and the subsequent annual wellness visit |
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Nursing Home Documentation Form |
A one-page form that standardizes and simplifies clinician documentation of nursing home care |
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Pertussis Encounter Form: Community Exposure |
A form to use throughout the process of contacting and treating patients who might have been exposed to pertussis in the community |
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Pulmonary Embolism Screening Encounter Form |
An evidence-based encounter form for evaluating pulmonary embolism risk |
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Skin Care Encounter Form |
An encounter form for rapidly and accurately coding skin-related diagnoses and associated procedures |
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Sore Throat Encounter Form |
An evidence-based encounter form for evaluating sore throats |
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Upper Respiratory Infection Encounter Form |
An encounter form for patients with upper respiratory infection symptoms that includes a patient questionnaire section and a physician evaluation section |
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Well-Male Exam Encounter Form |
A well-male exam encounter form that includes a patient-completed history, an exam documentation template and evidence-based screening test recommendations for all age groups |
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Well-Woman Exam Encounter Form (one-page) |
A visit-specific encounter form that shifts the responsibility for collecting patients’ health information to the patient and gives physicians more time during the encounter for preventive counseling or patient education |
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Well-Woman Exam Encounter Form (three-page) |
A well-woman exam encounter form that includes a patient-completed history, an exam documentation template and evidence-based screening test recommendations for all age groups |
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