File ENCOUNTER_FORM(357) Data List

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NAME	SIMPLEX/DUPLEX	BRIEF DESCRIPTION	TYPE OF USE	COMPILED?	USE ICR?	TOOLKIT	RIGHT MARGIN	PAGE LENGTH	NUMBER OF PAGES	SCANNED/MANUAL DATA ENTRY	FORM TYPE ID	PAPER SIZE	ORIENTATION	TEXT SIZE	VERSION	PAGE INFORMATION	CODING SYSTEM UPDATES
AMBULATORY SURGERY SAMPLE V2.1	DUPLEX,SHORT-EDGE BINDING	scannable form for ambulatory surgery	OUTPATIENT ENCOUNTER FORM	NO	YES	YES	133	80	2	YES		LETTER (8 1/2 x 11)	PORTRAIT	133 COLUMNS x 80 LINES	2.1	1 SCANNABLE?: YES, PAGE SCANNABLE 2 SCANNABLE?: YES, PAGE SCANNABLE
AUDIOLOGY ICD-10	DUPLEX,LONG-EDGE BINDING	NATIONAL AUDIOLOGY WITH ICD-10 CODES	OUTPATIENT ENCOUNTER FORM	NO	YES	YES	133	80	4	YES		LETTER (8 1/2 x 11)	PORTRAIT	133 COLUMNS x 80 LINES	2.1	1 SCANNABLE?: YES, PAGE SCANNABLE 2 SCANNABLE?: YES, PAGE SCANNABLE 3 SCANNABLE?: YES, PAGE SCANNABLE 2 SCANNABLE?: YES, PAGE SCANNABLE 4 SCANNABLE?: YES, PAGE SCANNABLE 5 SCANNABLE?: YES, PAGE SCANNABLE
CAREGIVER ASSESSMENT ICD-10	DUPLEX,SHORT-EDGE BINDING	CAREGIVER ASSESSMENT ICD-10 CODES October 2014	OUTPATIENT ENCOUNTER FORM	NO		YES	133	80	1	NO		LETTER (8 1/2 x 11)	PORTRAIT	133 COLUMNS x 80 LINES	3
CHEMO/ONCOLOGY ICD-10	DUPLEX,LONG-EDGE BINDING	NATIONAL ONCOLOGY W/ ICD-10	OUTPATIENT ENCOUNTER FORM	NO	NO	YES	133	80	6	YES		LETTER (8 1/2 x 11)	PORTRAIT	133 COLUMNS x 80 LINES	2.1	1 SCANNABLE?: YES, PAGE SCANNABLE 2 SCANNABLE?: YES, PAGE SCANNABLE 3 SCANNABLE?: YES, PAGE SCANNABLE 2 SCANNABLE?: YES, PAGE SCANNABLE 4 SCANNABLE?: YES, PAGE SCANNABLE 5 SCANNABLE?: YES, PAGE SCANNABLE
DAY/GEN SURG ICD-10 CODES	DUPLEX,SHORT-EDGE BINDING	DAY/GENERAL SURGERY ICD-10 CODES August 2014	OUTPATIENT ENCOUNTER FORM	NO		YES	133	80	17	NO		LETTER (8 1/2 x 11)	PORTRAIT	133 COLUMNS x 80 LINES	3
DEFAULTS	DUPLEX,LONG-EDGE BINDING	selection list defaults - DO NOT DELETE	OUTPATIENT ENCOUNTER FORM	NO	YES	YES	133	80	5	YES		LETTER (8 1/2 x 11)	PORTRAIT	133 COLUMNS x 80 LINES	2.1
E-CONSULTS ICD-10	DUPLEX,LONG-EDGE BINDING	NATIONAL E-CONSULT WITH ICD-10 CODES	OUTPATIENT ENCOUNTER FORM	NO	YES	YES	133	80	18	YES		LETTER (8 1/2 x 11)	PORTRAIT	133 COLUMNS x 80 LINES	2.1	1 SCANNABLE?: YES, PAGE SCANNABLE 2 SCANNABLE?: YES, PAGE SCANNABLE 3 SCANNABLE?: YES, PAGE SCANNABLE 2 SCANNABLE?: YES, PAGE SCANNABLE 4 SCANNABLE?: YES, PAGE SCANNABLE 5 SCANNABLE?: YES, PAGE SCANNABLE
EMERGENCY SERVICES SAMPLE V2.1	DUPLEX,SHORT-EDGE BINDING	scannable form for primary care	OUTPATIENT ENCOUNTER FORM	NO	YES	YES	133	80	2	YES		LETTER (8 1/2 x 11)	PORTRAIT	133 COLUMNS x 80 LINES	2.1	1 SCANNABLE?: YES, PAGE SCANNABLE 2 SCANNABLE?: YES, PAGE SCANNABLE
EMPLOYEE HEALTH ICD-10	DUPLEX,LONG-EDGE BINDING	EMPLOYEE HEALTH W/ ICD-10	OUTPATIENT ENCOUNTER FORM	NO	NO	YES	133	80	4	YES		LETTER (8 1/2 x 11)	PORTRAIT	133 COLUMNS x 80 LINES	2.1	1 SCANNABLE?: YES, PAGE SCANNABLE 2 SCANNABLE?: YES, PAGE SCANNABLE 3 SCANNABLE?: YES, PAGE SCANNABLE 2 SCANNABLE?: YES, PAGE SCANNABLE 4 SCANNABLE?: YES, PAGE SCANNABLE 5 SCANNABLE?: YES, PAGE SCANNABLE
ENT ICD-10	DUPLEX,LONG-EDGE BINDING	NATIONAL ENT W/ ICD-10 CODES	OUTPATIENT ENCOUNTER FORM	NO	NO	YES	133	80	2	YES		LETTER (8 1/2 x 11)	PORTRAIT	133 COLUMNS x 80 LINES	2.1	1 SCANNABLE?: YES, PAGE SCANNABLE 2 SCANNABLE?: YES, PAGE SCANNABLE 3 SCANNABLE?: YES, PAGE SCANNABLE 2 SCANNABLE?: YES, PAGE SCANNABLE 4 SCANNABLE?: YES, PAGE SCANNABLE 5 SCANNABLE?: YES, PAGE SCANNABLE

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