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PM Paper Superbill Template Examples

Known as Encounter Forms in Kareo PM, these Superbill templates are available for use within the application. Click on a title or thumbnail image below to view a sample of how the template will print. Once you decide on the ones you want to use, add them within Kareo.

Thumbnail Description
One Page.pdf.jpg

One Page

  • A one-page form with solid grid lines, procedures on top in three columns and diagnoses below in three columns.
  • The last column of diagnoses has space for a physician's signature.
One Page (Large Font).pdf.jpg

One Page (Large Font)

  • A one-page form with solid grid lines, procedures on top in three columns and diagnoses below in three columns.
  • The last column of diagnoses has space for a physician's signature. Just like "One Page", but the fonts used for the procedures and diagnoses are larger, touching the grid lines.
Two Page.pdf-0.jpgTwo Page.pdf-1.jpg

Two Page — Page 1 Page 2

  • A two-page form with solid grid lines.
  • The first page contains procedures in three columns.
  • The second page contains diagnoses in three columns, and a footer with space for a physician's signature.
Two Page (First Page Only).pdf.jpg

Two Page (First Page Only)

  • This is the first page of the “Two Page” form with solid grid lines.
  • The page contains procedures in three columns. Note that the second page containing diagnoses will not print.
Two Page Version 2.pdf-0.jpgTwo Page Version 2.pdf-1.jpg

Two Page Version 2 — Page 1 Page 2

  • A two-page form with dotted grid lines.
  • The first page contains procedures in three columns.
  • The second page contains diagnoses in three columns, and a footer with space for a physician's signature.
Two Page Version 2 (First Page Only).pdf.jpg

Two Page Version 2 (First Page Only)

  • This is the first page of the “Two Page Version 2” form with dotted grid lines.
  • The page contains procedures in four columns. Note that the second page will not print.
One Page Version 2.pdf.jpg

One Page Version 2

  • A one-page form with dotted grid lines.
  • Procedures are on top in four columns, and diagnoses are below taking up half the space in four columns.
  • The footer contains a return schedule box.
One Page No Grid Extended.png

One Page No Grid Extended

  • This one-page form includes a header with patient, insurance, appointment, account balance, and payment information.
Two Page Four Column Grid.pdf-0.jpgTwo Page Four Column Grid.pdf-1.jpg

Two Page Four Column Grid — Page 1 Page 2

  • A two-page form with dotted grid lines.
  • The first page contains procedures in four columns, and a footer with a return schedule box.
  • The second page contains diagnoses in four columns, and a footer with space for a physician's signature.
Two Page with Recent Diagnoses.pdf-0.jpgTwo Page with Recent Diagnoses.pdf-1.jpg

Two Page with Recent Diagnoses — Page 1 Page 2

  • A two-page form with dotted grid lines.
  • The first page contains six recent diagnoses for the current patient and case in three columns, followed by procedures arranged in three columns.
  • The second page contains diagnoses in three columns, and a footer with space for a physician's signature.
1-Page, 3-Column with Recent Diagnoses.pdf.jpg

1-Page, 3-Column with Recent Diagnoses

  • A one-page form with dotted grid lines, six recent diagnoses on the same case for the current patient in three columns at the top, followed by the normal diagnosis list in three columns, followed by procedures in three columns.
  • The last column of procedures has space for a physician's signature.

1-Page, 4-Column with Recent Diagnoses.pdf.jpg

1-Page, 4-Column with Recent Diagnoses

  • A one-page form with dotted grid lines, eight recent diagnoses on the same case for the current patient in four columns at the top, followed by the normal diagnosis list in four columns, followed by procedures in four columns.
  • The last column of procedures has space for a physician's signature.
One Page Four Column.pdf.jpg

One Page Four Column

  • A one-page form with solid grid lines.
  • Procedures are on top in four columns, with diagnoses taking up half the space below in four columns.
  • Header contains space for patient account status and a return schedule box.
One Page More Diagnoses.pdf.jpg

One Page More Diagnoses

  • A one-page form with dotted grid lines, procedures on top in four columns, and diagnoses below taking up twice as much space in four columns.
  • Footer contains a return schedule box.
One Page Blank Fourth Columns.pdf.jpg

One Page Blank Fourth Columns

  • A one-page form with dotted grid lines, procedures on top in four columns taking up twice as much space as diagnoses below in four columns.
  • The fourth column of procedures and diagnoses is left blank, and has no grid lines, to allow for notes.
  • The last column of diagnoses has space for a physician's signature.
  • The footer contains a return schedule box.
blank-encounter-form.png

Blank Encounter Form with Header

  • A one-page form that is blank with a header.
  • The header contains patient, insurance, appointment, account activity, and payment information.
  • This form gives you the flexibility to construct the layout to your liking outside of Kareo and print over the header. 
1-Page, 2-Column Procedures.pdf.jpg

1-Page, 2-Column Procedures

  • A one-page form with dotted grid lines, procedures on top in two columns, taking up the larger part of the page, and diagnoses below in four columns, taking up a smaller part of the page.
  • Contains a return schedule box.
One Page Equal Spacing.pdf.jpg

One Page Equal Spacing

  • A one-page form with solid grid lines.
  • Procedures are on top in four columns, with diagnoses taking up an equal space below in four columns.
  • Header contains space for patient account status and a return schedule box.
One Page ASF Ortho.pdf.jpg

One Page AO

  • A one-page form with solid grid lines and yellow highlighting for headers and footer.
  • Diagnoses on top are in four columns and take up twice as much room as the procedures below, also in four columns.
  • The footer contains space for patient's and physician's signatures.
One Page Three Column.pdf.jpg

One Page Three Column

  • A one-page form with solid grid lines.
  • There are nine rows of procedures in three columns, with the rest of the space below taken up by diagnoses in three columns.
One Page No Grid Lines.pdf.jpg

One Page No Grid Lines

  • A one-page form with no grid lines.
  • Procedures are on top in four columns, diagnoses are below in four columns.
blank-encounter-form-header-footer.png

Blank Encounter Form with Header Footer

  • A one-page form that includes a header and footer and is blank in the middle.
  • The header contains patient, insurance, and appointment information, and the footer includes account balance, account activity, and payment info. 
  • This form gives you the flexibility to construct the layout to your liking outside of Kareo and print over the header and footer . 
1-Page, No Grid Lines with More Diagnoses.pdf.jpg

1-Page, No Grid Lines with More Diagnoses 

  • A one-page form with no grid lines, with ten rows of procedures in four columns on top, and diagnoses taking up more space below in four columns.
One Page Dr. McNeill.pdf.jpg

One Page DMN

  • A one-page form with no grid lines.
  • Procedures are on top in three columns and contain space for a fee.
  • Diagnoses are below in four columns and are numbered.
One Page No Grid Lines Version 2.pdf.jpg

One Page No Grid Lines Version 2

  • A one-page form with no grid lines.
  • Procedures are on top in four columns, diagnoses are below taking up almost twice the space in four columns.
  • The form uses smaller fonts than the "One Page No Grid Lines" form, and can fit more entries in the lists.
One Page Dr. Bastidas.pdf.jpg

One Page DB

  • A one-page form with no grid lines, with procedures on top in one wide column containing spaces for modifier and fee.
  • Diagnoses are below in two columns.
One Page No Diagnoses Section.pdf.jpg

One Page No Diagnoses Section

  • A one-page form with solid grid lines, only listing procedures in three columns and contains space for a fee.
  • The footer has space for a fill-in diagnosis.
1-Page, 4-Column with 3 Insurances.pdf.jpg

1-Page, 4-Column with 3 Insurances

  • A one-page form with solid grid lines.
  • Procedures take up the vast majority of the page, arranged in four columns.
  • Diagnoses are at the bottom, in four columns.
  • The page header contains a return schedule box, and has space for primary, secondary and tertiary insurance.
1-Page, Original with More Diagnoses.pdf.jpg

1-Page, Original with More Diagnoses

  • A one-page form with solid grid lines, procedures on top in three columns and diagnoses below in three columns.
  • The last column of diagnoses has space for a physician's signature.
  • Has slightly more diagnoses than "One Page" form.
1-Page, 3-Column with Equal Spacing.pdf.jpg

1-Page, 3-Column with Equal Spacing

  • A one-page form with solid grid lines, procedures on top in three columns, taking up as much space as diagnoses below, also in three columns.
1-Page, 3-Column with 3 Insurances Big Font.png

1-Page, 3-Column with 3 Insurances Big Font

  • A one-page form with solid grid lines.
  • Procedures take up the vast majority of the page, arranged in three columns.
  • Diagnoses are at the bottom, in three columns.
  • The page header contains a return schedule box, and has space for primary, secondary and tertiary insurance.

 

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