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Free Paper Forms

Your value lies in your data. It’s in your outcomes, efficiencies, and utilization. Graphium Health makes collecting and reporting your anesthesia data meaningful. Whether it’s quality compliance, revenue cycle management, operational excellence, hosptial credentialing, or competing for new contracts, you need actionable data to prove your value and improve the surgical patient experience. Once all your data is centralized, you’ll understand why so many people love using Graphium Health.

MACRA Ready Compliance

Intelligent documentation starts with the right form. Choose the one that works best for you.

MACRA Simple Form

Compliance + Quality

Sure you practice world-class care, but can you measure it? CMS holds providers accountable by requiring onerous reports demonstrating safety and quality measures. They reduce your payments when you can’t. And your hospital needs similar reports for both your credentialing and theirs. Showing them how great you really are starts with intelligent data capture.

MACRA Plus Form

Compliance + Quality + Operational Excellence

If you’re already capturing compliance and quality data, let’s take it to the next level. With 7 additional fields, our MACRA Plus form enables you to monitor Operational Excellence. Some additional reports beyond compliance include:

  • First Case On-time Starts
  • Cost of First Case Delays
  • Surgeon Turn over Times
  • Anesthesia Turn over Times
  • Anes Ready Times
  • OR staffing utilization

Charge Capture Form

Our clients want to streamline their current paper form processes. Get rid of your Face Sheets and combine your claim slip with our best-in-class compliance forms. Welcome to Charge Capture on steroids. Feel confident that you are recording what you need for MACRA Compliance and Quality, Operational Excellence, and now Charge Capture. Once in our platform, your data is ready for electronic submission to the RCM vendor of your choice. With Graphium, it really is that easy. Feel free to contact us about customizing your Charge Capture form.

Fax the Forms to Graphium

Our team of data entry specialists will get your data entered into our data warehouse, unlocking Anesthesia MACRA Compliance, Operational Excellence, Charge Capture, and even Full RCM services to your group.

Print the forms today, start collecting the data, and we'll let you know where to fax them.

Full Anesthesia Forms

Why duplicate all this data entry? Document it once in the anesthesia record and let us take care of the rest so you can focus on keeping patients safe.

General Anesthesia Record

Our General Anesthesia OR form is designed to collect everything a modern practice needs. It includes PreOp, Intraop, Extra Time, Regional, PostOp, and Complication pages.

Labor Anesthesia Record

Our Labor Anesthesia form again has the same minumum data set you need for success, but laboring women represent a different workflow than General Anesthesia. It includes pages specifically designed to cover these cases while ensuring intelligent data capture.

Short Anesthesia Record

Our Short Anesthesia OR form has the same minumum data set as above, but it’s geared toward common short and simple cases such as endoscopy, opthalmology, and ENT. It includes similar pages as the General Form above.

Ever considered eliminating all the paper in your practice?

We can help. Let us show you how our customers have replaced their couriers, carbon copies, and fax machines with the easiest to use Anesthesia platform on the market.

MACRA Compliance

$459/provider per yr*
  • Welcome to compliance with meaning. Combining Anesthesia Quality with Compliance gives you the reports you need to partner with your hospital and avoid hefty fines.
  • QCDR Registration and Reporting
  • Anesthesia Quality Dashboards
  • Operational Excellence (optional)
  • Enterprise and Facility Scorecards
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  • *Additional fees may apply

Charge Capture

$2.99/case*
  • If we're already capturing your compliance and quality data, we've almost completed a charge capture form. Let's take it one step further.
  • Full Charge Capture Fields: More Start/Stop times, CPT/ICD codes, Special modifiers, Additional procedures, etc.
  • QCDR Registration and Reporting
  • Anesthesia Quality Dashboards
  • Operational Excellence (optional)
  •  
  • *Additional fees may apply