Encounter Forms

Encounter Forms

The link below for the Pediatric Encounter Form is in Excel format

Please feel free to:

  • Use this tool to assist you in coding for claims submission and pay for performance measure
  • Modify the form to best suit your practice needs
  • Add medications, procedures, and other services that you frequently offer


The ICD-10 codes have been provided for your use, beginning 10/01/2015

If you have any questions, please call 844-THC-DOCS (844-842-3627)