Obgyn Encounter Form – Fill Out and Use This PDF

The Obgyn Encounter Form is an essential tool used by ob/gyns to ensure their patients receive the proper care. It functions as a checklist which addresses a wide range of items, ensuring that proper coverage is provided for all pertinent consultations and treatments. This important document provides both patient and doctor with an accurate and detailed account of the medical conditions discussed for medical records and billing purposes. Additionally, the form serves to protect practitioners from any liability that may arise from patient treatment due to its exhaustive nature. By cataloguing each step taken in evaluation and treatment, it serves as a trail that demonstrates quality and professional care given to patients.

Obgyn Encounter Form PDF Details

Are you searching for a streamlined and efficient way to document your patient visits? Obgyn Encounter Forms are the perfect solution! They provide a comprehensive means of collecting all pertinent information about each individual visit and allowing quick reference in the future. Obgyn Encounter Forms make it easy to record important data during consultations, no matter how busy or varied your practice may be. With this helpful resource at hand, you can feel confident that your office runs smoothly & accurately from start to finish!

Question	Answer
Form Name	Obgyn Encounter Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	gyne encounter forms, ob encounter, ob gyn encounter sample, ob gyn encounter form template

Form Preview Example

OB/GYN Encounter Form

Mail to:

Claims Department

Amerigroup

P.O. Box 61010

Virginia Beach, VA 23466-1010

Member Information	Provider Information

Last Name:	Provider Name:

First Name:	Phone #:		Provider ID #:
Member ID #:	Date of Birth:	Fax #:		Date of Visit:

	Address:

Level of Care: Please circle at least one CPT (Procedure) Code.

	Preventive/Physical				Office Visit			Counseling
	Preventive/Physical				Office Visit			Counseling

Age		New Patient	Established		New Patient	Established		Code	Length of Time
			Patient			Patient

12–17		99384	99394	99201		99211	99401		15 minutes
18–39		99385	99395	99202		99212	99402		30 minutes
40–64		99386	99396	99203		99213	99403		45 minutes
65+		99387	99397	99204		99214	99404		60 minutes

				99205		99215

Diagnosis Codes: Please indicate primary, secondary, and tertiary codes (1, 2, 3).

*If elements of wellness care were performed, please mark a wellness code as a secondary diagnosis.

Well Care/Preventive ICD-9 Codes	___ V67.9 Follow-up Exam, Unspec	___ 645.03 Prolonged, Antepartum
___ V70.0 Routine Physical (12+)	Contraception	___ 651.03 Twins, Antepartum
___ V70.3 General Medical Exam	___ V25.01 Rx Oral Contraceptive	Menstruation
___ V70.5 Health Exam	___ V25.02 Initiation, Other Contrcp	___ 636.8 Abnrml Bldg Genital Tract
	Method
___ V70.6 Health Exam in pop survey	___ V25.09 Mgmt, Contrcp, Other	___ 626.0 Amenorrhea

___ V70.8 Other specified gen med exam	___ V25.40 Surveillance, Unspecified	___ 625.3 Dysmenorrhea

___ V70.9 Gnrl Medical Exam, unspec	___ V25.41 Surveillance, Oral Cntrcp	___ 626.4 Irregular Menstrual Cycle
Counseling ICD-9 Codes	___ V25.49 Surveillance, Other	___ 627.2 Menopause/Clmctrc sts
	Method
___ V65.3 Dietary Counseling	Cancer Screening	___ 626.6 Metrorrhagia
___ V65.41 Exercise	___ 233.1 CA in Situ, Cx	___ 627.1 Postmenopausal Bldg

___ V65.42 Substance Use/Abuse	___ 622.1 Dysplas Cx (Uteri)	___ 626.2 XS/Frequent Menstruation

___ V65.43 Injury Prevention	___ 218.9 Leiomyo Uter, Unspec	GYN
___ V65.44 HIV Counseling	___ 184.8 Malgn Genital Neoplasm	___ 789.00 Abdominal Pain
___ V65.45 STD Counseling	___ 180.9 Malgn Neoplasm Cx	___ 112.9 Candidiasis, Unspec

___ VTOB Tobacco	Pregnancy Postpartum	___ 112.1 Candidiasis, Vulva/Vagina
Other Preventive ICD-9 Codes	___ 637.91 Ab. Legal, Incomplete	___ 616.0 Cervicitis/Endocervicitis
___ V76.2 Routine Pap Smear	___ 635.92 Ab. Legal Induced,	___ 595.0 Cyctitis, Acute
	Complete
___ V22.2 Pregnant State, Incidental	___ 634.91 Ab. Spon, Incomplete	___ 628.9 Infertility, Female

PF-ALL-0078-12

___ V22.1	Pregnancy, Supervision Other		___ 634.92 Ab.Spon, Complete		___ 616.9 Inflam dx of cx/vag/vulva
Norm
___ V23.7	Supervision, Hi Risk, Insuff		___ 640.03 Ab. Threatened,		___ 623.5 Leukorrhea
Prenatal			Anteprtm
___ V28.8 Screening, Antenatal, Other			___ 669.71 C-sect w/0 mention of		___623.8 Noninflam dx of Vagina
spec.			indic
___ V23.89 Supervision, Other High Risk			___ 650 Delivery, Normal		___ 620.2 Ovarian Cyst

___ V23.9	Supervision, Unspec High Risk		___ 633.9 Ectopic, Unspec		___ 614.9 PID

___ V27.0	Mother with single liveborn		___ 655.83 Fetal Abnormalities		___ 618.8 Uterine Prolapse
___ V61.5	Multiparity		___ 656.3 Fetal Distress		___ 599.0 UTI
___ V24.1 Postpartum Care and Exam			___ 656.53 Fetal Growth, Poor		___ 618.0 Vaginal Prolapse
Lactat Mthr

___ V24.2 Postpartum, Routine			___ 656.63 Fetal Grown, Excess		___ 054.11 Vulvovag, Herp

___ V67.0	Follow-up Exam After Surgery		___ 644.13 False Labor		___ 131.01 Vulvolag, Trich
___ V58.49 After Care for Surgery			___ 653.53 Fetal Growth, Unusually		___ Other
			Large
___ V72.4	Test, Pregnancy Unconfirmed		___ 648.8 Gestational Diabetes		___ Other
___ V61.7 Unwanted Pregnancy, Other			___ 659.63 Pregnancy > 35 years of		___ Other
			age

___ Other			___ Other		___ Other

Laboratory Tests/Screening – For Data Collection Purposes
___ 83036 HbA1c		__ 84520 BUN		___ 82951 GTT		___ 87110 Chlamydia (culture)
___ 83655 Blood Lead		__ 80061 Lipid Panel		___ 86901 Rh		___ 87590 GC (direct probe)

___ 88141 Pap Smear		__ 84439 Free T4		___ 86762 Rubella Titer		___ 87340 HepB surface antgn

___ 85025 CBC With Diff		__ 87086 Urine Culture		___ 82106 Alpha-		___ 87528 Herpes simplex (dir)
				Fetoprotein

___ 86900 Blood Typing		__ 81000 Urinalysis		___ 83661 Fetal Lung Mat		___ 87207 Herpes (smear)
				(L/S)
___ 86580 Mantoux Test		__ 84550 Uric Acid		___ 86592 VDRL		___ 82043 Microalbumin
(TB)						Quantity

Print Physician Name

Physician Signature and Date of Signature

PF-ALL-0078-12

How to Edit Obgyn Encounter Form Online for Free

You are able to fill out ob gyn superbill template effectively using our online PDF tool. In order to make our editor better and more convenient to use, we continuously work on new features, taking into consideration feedback coming from our users. Should you be seeking to get started, this is what it will take:

Step 1: Open the form inside our editor by clicking the "Get Form Button" at the top of this webpage.

Step 2: Once you open the tool, you'll see the form ready to be filled in. Other than filling out various fields, you might also perform other things with the form, specifically adding your own words, editing the initial textual content, adding illustrations or photos, affixing your signature to the document, and much more.

Pay attention when completing this document. Make sure all necessary blanks are completed properly.

1. When completing the ob gyn superbill template, make sure to include all of the needed blank fields within the associated part. It will help expedite the process, allowing your information to be handled efficiently and correctly.

Step no. 1 of completing ob gyn superbill

2. The next part is to fill out these blanks: V Routine Physical V General, Contraception V Rx Oral, Twins Antepartum Menstruation, Method, V Health Exam in pop survey V, V Surveillance Oral Cntrcp, MenopauseClmctrc sts, V Mgmt Contrcp Other, Amenorrhea, V Dietary Counseling V Exercise, Method, Cancer Screening CA in Situ Cx, Complete, and Metrorrhagia Postmenopausal.

Part number 2 in filling out ob gyn superbill

3. In this specific part, take a look at Complete, V Pregnant State Incidental, Ab Spon Incomplete, Infertility Female, and PFALL. Each one of these are required to be filled in with greatest awareness of detail.

The right way to fill in ob gyn superbill step 3

Lots of people generally make some mistakes when filling out V Pregnant State Incidental in this section. Ensure that you re-examine whatever you type in here.

4. The form's fourth subsection arrives with the following blanks to focus on: V Pregnancy Supervision Other, AbSpon Complete, Inflam dx of cxvagvulva, Norm, V Supervision Hi Risk Insuff, Ab Threatened, Leukorrhea, Prenatal, Anteprtm, V Screening Antenatal Other, Csect w mention of, Noninflam dx of Vagina, spec, indic, and V Supervision Other High Risk V.

ob gyn superbill completion process outlined (step 4)

5. The form has to be wrapped up by filling in this segment. Here you can see an extensive set of form fields that need accurate details in order for your form submission to be complete: Other Laboratory TestsScreening, BUN Lipid Panel Free T, Chlamydia culture GC direct, GTT Rh Rubella Titer Alpha, Blood Typing, Urinalysis, Fetal Lung Mat, Herpes smear, Mantoux Test, Uric Acid, VDRL, Microalbumin, Print Physician Name, Physician Signature and Date of, and Quantity.

Uric Acid, Print Physician Name, and Fetal Lung Mat in ob gyn superbill

Step 3: Spell-check everything you have inserted in the blanks and then click the "Done" button. Sign up with us now and easily get access to ob gyn superbill template, prepared for download. All modifications made by you are preserved , so that you can customize the file at a later time as required. FormsPal ensures your data confidentiality by having a protected method that in no way saves or distributes any kind of private information involved in the process. You can relax knowing your docs are kept protected any time you work with our services!

Obgyn Encounter Form – Fill Out and Use This PDF

Obgyn Encounter Form PDF Details

Form Preview Example

How to Edit Obgyn Encounter Form Online for Free

Obgyn Encounter Form isn’t the one you’re looking for?

Related Documents