Home
Products
Articles
FAQ
About Us
Patient Information
History
Physical Exam
Medical Decision
Risk Decision
Calculate
Patient ID:
Visit Date:
Service Category
Office Visit
Hospital Visit
Consultations
Emergancy Department Services
Critical Care
Neonatal Intensive Care
Nursing Facility Services
Domicilary, Rest Home, or Custodial Care Services
Home Services
Prolonged Services
Case Management Services
Care Plan Oversight Services
Preventive Medicine Services
Newborn Care
Special Services
Other Services
Patient Transport
Patient Name:
Total Time:
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
80
85
90
95
100
105
110
115
120
135
150
165
180
195
Date of Birth:
Age:
Time Counseling:
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
80
85
90
95
100
105
110
115
120
135
150
165
180
195
Gender
Male
Female
Examined By:
Service Type
Evaluation of Presenting Problem
Recheck of Presenting Problem
Eyes, Henry
Patient Status
New
Established
Visit Notes
This is a sample note for this visit.
Modifier
None
Prolonged
Unrelated
Seperately identifiable
Mandated
Reduced
Decision for surgery
This site is best viewed in Internet Explorer
This intranet application is copyright Spring Management System, Inc. 2004
(800) 585-6337
www.springmgmt.com
