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Description |
![Sample of One Page Encounter Form](https://helpme.tebra.com/@api/deki/files/10754/One_Page.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with solid grid lines.
- Procedures on top in three columns.
- Diagnoses are below in three columns and the last column has space for a physician's signature.
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![Sample of One Page Large Font Encounter Form](https://helpme.tebra.com/@api/deki/files/10751/One_Page_(Large_Font).png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with solid grid lines just like "One Page", but the fonts used for the procedures and diagnoses are larger, touching the grid lines.
- Procedures on top in three columns.
- Diagnoses are below in three columns and the last column has space for a physician's signature.
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![Sample of Two Page Encounter Form, Page 2](https://helpme.tebra.com/@api/deki/files/10730/Two_Page_-_Page_2.png?revision=1&size=bestfit&width=123&height=160) |
- A two-page form with solid grid lines.
- The first page contains procedures in three columns.
- The second page contains diagnoses in three columns, and a footer with space for a physician's signature.
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![Sample of Two Page Encounter Form, First Page Only](https://helpme.tebra.com/@api/deki/files/10752/Two_Page_(First_Page_Only).png?revision=1&size=bestfit&width=124&height=160) |
- This is the first page of the “Two Page” form with solid grid lines.
- The page contains procedures in three columns.
- The second page containing diagnoses and footer does not print.
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![Sample of Two Page Version 2 Encounter Form, Page 2](https://helpme.tebra.com/@api/deki/files/10722/Two_Page_Version_2_-_Page_2.png?revision=1&size=bestfit&width=123&height=160) |
- A two-page form with dotted grid lines.
- The first page contains procedures in three columns.
- The second page contains diagnoses in three columns, and a footer with space for a physician's signature.
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![Sample of Two Page Version 2 Encounter Form, First Page Only](https://helpme.tebra.com/@api/deki/files/10732/Two_Page_Version_2_(First_Page_Only).png?revision=1&size=bestfit&width=124&height=160) |
- This is the first page of the “Two Page Version 2” form with dotted grid lines.
- The page contains procedures in four columns.
- The second page containing diagnoses and footer does not print.
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![Sample of One Page No Grid Extended Encounter Form](https://helpme.tebra.com/@api/deki/files/10723/One_Page_No_Grid_Extended.png?revision=1&size=bestfit&width=124&height=160) |
- This one-page form that is blank with a header.
- The header contains patient, insurance, appointment, account balance, and payment information.
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![Sample of One Page Version 2 Encounter Form](https://helpme.tebra.com/@api/deki/files/10743/One_Page_Version_2.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with dotted grid lines.
- Procedures are on top in four columns.
- Diagnoses are below in four columns and takes up half the space as the procedures.
- The footer contains a return schedule box.
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Two Page Four Column Grid — Page 1 , Page 2
- A two-page form with dotted grid lines.
- The first page contains procedures in four columns, and a footer with a return schedule box.
- The second page contains diagnoses in four columns, and a footer with space for a physician's signature.
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![Sample of Two Page with Recent Diagnoses Encounter Form, Page 2](https://helpme.tebra.com/@api/deki/files/10725/Two_Page_with_Recent_Diagnoses_-_Page_2.png?revision=1&size=bestfit&width=123&height=160) |
Two Page with Recent Diagnoses — Page 1 , Page 2
- A two-page form with dotted grid lines.
- The first page contains six recent diagnoses for the current patient and case in three columns, followed by procedures arranged in three columns.
- The second page contains diagnoses in three columns, and a footer with space for a physician's signature.
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![Sample of 1 Page 3 Column with Recent Diagnoses Encounter Form](https://helpme.tebra.com/@api/deki/files/10749/1-Page%252C_3-Column_with_Recent_Diagnoses.png?revision=2&size=bestfit&width=124&height=160) |
- A one-page form with dotted grid lines.
- Six recent diagnoses for the current patient and case in three columns at the top, followed by the normal diagnosis list in three columns.
- Procedures are below in three columns, and the last column of has space for a physician's signature.
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![Sample of 1 Page 4 Column with Recent Diagnoses Encounter Form](https://helpme.tebra.com/@api/deki/files/10742/1-Page%252C_4-Column_with_Recent_Diagnoses.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with dotted grid lines.
- Eight recent diagnoses for the current patient and case in four columns at the top, followed by the normal diagnosis list in four columns.
- Procedures are below in four columns and the last column of has space for a physician's signature.
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![Sample of One Page Four Column Encounter Form](https://helpme.tebra.com/@api/deki/files/10736/One_Page_Four_Column.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with solid grid lines.
- The header contains space for patient account status and a return schedule box.
- Procedures are on top in four columns.
- Diagnoses are below in four columns and takes up half the space as the procedures.
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![Sample of One Page More Diagnoses Encounter Form](https://helpme.tebra.com/@api/deki/files/10741/One_Page_More_Diagnoses.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with dotted grid lines.
- Procedures on top in four columns.
- Diagnoses are below in four columns and takes up twice the space as the procedures.
- The footer contains a return schedule box.
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![Sample of One Page Blank Fourth Columns Encounter Form](https://helpme.tebra.com/@api/deki/files/10739/One_Page_Blank_Fourth_Columns.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with dotted grid lines.
- Procedures on top in four columns and takes up twice as much space as diagnoses below in four columns.
- The last column of procedures and diagnoses is blank with no grid lines to allow for notes.
- The last column of diagnoses has space for a physician's signature.
- The footer contains a return schedule box.
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![Sample of Blank Encounter Form with Header](https://helpme.tebra.com/@api/deki/files/10719/Blank_Encounter_Form_with_Header.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form that is blank with a header.
- The header contains patient, insurance, appointment, account activity, and payment information.
- This form provides flexibility to construct the layout as desired outside of Kareo.
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![Sample of 1 Page, 2 Column Procedures Encounter Form](https://helpme.tebra.com/@api/deki/files/10746/1-Page%252C_2-Column_Procedures.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with dotted grid lines.
- Procedures on top in two columns.
- Diagnoses are below in four columns and takes up half the space as the procedures.
- The footer contains a return schedule box.
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![Sample of One Page Equal Spacing Encounter Form](https://helpme.tebra.com/@api/deki/files/10744/One_Page_Equal_Spacing.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with solid grid lines.
- Procedures are on top in four columns.
- Diagnoses are below in four columns and takes up an equal space as the procedures.
- The header contains space for patient account status and a return schedule box.
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![Sample of One Page AO Encounter Form](https://helpme.tebra.com/@api/deki/files/10747/One_Page_AO.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with solid grid lines and yellow highlighting for headers and footer.
- Diagnoses on top are in four columns.
- Procedures are below in four columns and takes up half the space as the diagnoses.
- The footer contains space for patient's and physician's signatures.
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![Sample of One Page Three Column Encounter Form](https://helpme.tebra.com/@api/deki/files/10720/One_Page_Three_Column.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with solid grid lines.
- There are nine rows of procedures in three columns on top.
- Diagnoses are below in three columns and takes up the rest of the page.
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![Sample of One Page No Grid Lines Encounter Form](https://helpme.tebra.com/@api/deki/files/10726/One_Page_No_Grid_Lines.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with no grid lines.
- Procedures are on top in four columns.
- Diagnoses are below in four columns and takes up an equal space as the procedures.
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![Sample of Blank Encounter Form with Header Footer](https://helpme.tebra.com/@api/deki/files/10755/Blank_Encounter_Form_with_Header_Footer.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with a header and footer that is blank in the middle.
- The header contains patient, insurance, and appointment information.
- The footer contains account balance, account activity, and payment information.
- This form gives flexibility to construct the layout as desired outside of Kareo.
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![Sample of 1 Page, No Grid Lines with More Diagnoses Encounter Form](https://helpme.tebra.com/@api/deki/files/10729/1-Page%252C_No_Grid_Lines_with_More_Diagnoses.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with no grid lines.
- There are ten rows of procedures in four columns on top.
- Diagnoses are below in four columns and takes up twice the space as the procedures.
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![Sample of One Page DMN Encounter Form](https://helpme.tebra.com/@api/deki/files/10734/One_Page_DMN.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with no grid lines.
- Procedures are on top in three columns and contain space for a fee.
- Diagnoses are below in four columns and are numbered.
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![Sample of One Page No Grid Lines Version 2 Encounter Form](https://helpme.tebra.com/@api/deki/files/10727/One_Page_No_Grid_Lines_Version_2.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with no grid lines.
- Procedures are on top in four columns.
- Diagnoses are below in four columns and takes up twice the space as the procedures.
- The form uses smaller fonts than the "One Page No Grid Lines" form, and can fit more entries in the lists.
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![Sample of One Page DB Encounter Form](https://helpme.tebra.com/@api/deki/files/10745/One_Page_DB.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with no grid lines.
- Procedures are on top in one wide column that contains spaces for modifiers and fees.
- Diagnoses are below in two columns.
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![Sample of One Page No Diagnoses Section Encounter Form](https://helpme.tebra.com/@api/deki/files/10724/One_Page_No_Diagnoses_Section.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with solid grid lines.
- Only lists procedures in three columns and contains space for a fee.
- The footer has space for a fill-in diagnosis.
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![Sample of 1 Page, 4 Column with 3 Insurances Encounter Form](https://helpme.tebra.com/@api/deki/files/10733/1-Page%252C_4-Column_with_3_Insurances.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with solid grid lines.
- The header contains a return schedule box, and has space for primary, secondary and tertiary insurance.
- Procedures take up the vast majority of the page, arranged in four column.
- Diagnoses are at the bottom of the page in four columns.
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![Sample of 1 Page, Original with More Diagnoses Encounter Form](https://helpme.tebra.com/@api/deki/files/10753/1-Page%252C_Original_with_More_Diagnoses.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with solid grid lines.
- Procedures on top in three columns.
- Diagnoses are below in three columns and the last column has space for a physician's signature.
- This form has slightly more diagnoses than "One Page" form.
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![Sample of 1 Page, 3 Column with Equal Spacing Encounter Form](https://helpme.tebra.com/@api/deki/files/10738/1-Page%252C_3-Column_with_Equal_Spacing.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with solid grid lines.
- Procedures on top in three columns.
- Diagnoses are below in three columns and takes up an equal space as the procedures.
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![Sample of 1 Page, 3 Column with 3 Insurances Big Font Encounter Form](https://helpme.tebra.com/@api/deki/files/10735/1-Page%252C_3-Column_with_3_Insurances_Big_Font.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with solid grid lines.
- The page header contains a return schedule box, and has space for primary, secondary and tertiary insurance.
- Procedures take up the vast majority of the page, arranged in three columns.
- Diagnoses are at the bottom of the page in three columns.
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![Sample of One Page Four Column Grid Encounter Form](https://helpme.tebra.com/@api/deki/files/10728/One_Page_Four_Column_Grid.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with dotted grid lines.
- Procedures take up the vast majority of the page, arranged in four columns.
- The footer contains a space for notes, a return schedule box and space for a physician's signature.
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![Sample of One Page Mods and Fees Encounter Form](https://helpme.tebra.com/@api/deki/files/10750/One_Page_Mods_and_Fees.png?revision=1&size=bestfit&width=124&height=160) |
- A one-page form with solid grid lines.
- Procedures take up the vast majority of the page, arranged in two columns, and contains modifiers and fees.
- Diagnoses are below in three columns and the last column has space for a physician's signature.
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