Providers
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)