Medical encounter form

Details Medical encounter form Medical encounter form

1997-01-23

1998-08-11

Fridie, Jr., Willmon

Printed matter

Accounting or listing form or sheet

283115, B42D 1100

Patent

active

057916918

ABSTRACT:
A medical encounter form, and a method for simultaneously recording pertinent patient and financial information onto patient encounter forms and onto a medical provider maintained daily log, for improving a medical provider's ability to minimize inconsistencies and validate entries. The medical encounter form comprises three sheets: a master sheet for recording data, a second sheet for duplicate copy, and a specialized third sheet for ink transfer to an underlying surface. The master sheet is provided with a pressure-sensitive inked back side for making a duplicate copy of varying data onto the second sheet. The face of each such sheet includes a columnar preprinted area for entry of patient examination information and aa preprinted row including areas for printing information regarding the fee for services rendered. The zone transfer sheet is limited to having a narrow strip of pressure sensitive image-reproductive material on its back side. The three sheet form is overlain a data log sheet on a ledger board by manually aligning a pin-feed edge over the pegs of the ledger board, aligning the fee for services rendered line on the next available daily log sheet entry line. The image-reproductive strip on the back side of the third sheet is exposed to the face of the underlying daily log sheet, allowing pressure exerted by a writing instrument to simultaneously transfer the information written in the fee for services line to the daily log entry line, creating three record copies simultaneously.

REFERENCES:
patent: 3661407 (1972-05-01), Warren
patent: 5088961 (1992-02-01), Sprain
patent: 5413383 (1995-05-01), Laurash et al.

Affiliated with

Also associated with

Rating

Medical encounter form does not yet have a rating. At this time, there are no reviews or comments for this patent.

If you have personal experience with Medical encounter form, we encourage you to share that experience with our LandOfFree.com community. Your opinion is very important and Medical encounter form will most certainly appreciate the feedback.

Rate now

Comments { 0 }

Profile ID: LFUS-PAI-O-381570