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Patient Encounter Form


This form can be used as a model for clinicians to establish a reminder system to improve quality measures and goals.

Patient visits can be guided by this customizable patient encounter form that is designed to incorporate a practice’s quality goals and measures. It can be printed automatically at patient arrival, manually on demand, or completed using a real-time Web interface.

In addition to documenting services due, diagnoses and problems, and actions taken, the system captures elements that do not appear in billing or administrative data such as patient lifestyle characteristics, clinical results such as blood pressure, non-billable diagnoses such as obesity, and non-billable treatments such as recommending aspirin for heart disease patients. These elements may be important for quality improvement documentation requirements.
Links to the Tool:
This tool is available at:


University of Michigan, Department of Family Medicine

Funding Sources

University of Michigan, Department of Family Medicine

QualityTool Topic



  • Release Date: 11/2005
  • Original Summary: 04/2009
Disclaimer: The inclusion of a tool in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality or Westat of the tool or of the submitter or developer of the tool. Read more.
QualityTool Classification
Setting of Care:
Patient Care Process:

Last updated: April 27, 2009.