An Office Encounter form is divided into four different parts, including information about patient, services, modifiers, and summary. Record complete information about the patient in this form, including patient ID number, patient name, address of patient, city or state, social security number, date of birth, age, and contact number. Payment method is also listed in detail including primary ID number, primary group number secondary ID number, secondary group number, and cash, credit card, or other billing information. Detailed visit information is also mentioned in this form including the date of visit, visit number, rendering physician, referring physician, and reason for visit.
The following is an example of an Office Encounter form: