A(n) ________, or encounter form, includes the charges for services rendered on that day, a request for payment or insurance copayment, and all the information for submitting an insurance claim.

Encounter Form

A form that combines the charges for services rendered, an invoice for payment or insurance copayment, and all the information for submitting an insurance claim; also known as a superbill.

Charges for Services

The costs associated with healthcare services, procedures, and treatments that are billed to patients or insurance companies.