Texas Health Care, P.L.L.C.
I.T./NextGen
DELETE ENCOUNTER AUTHORIZATION FORM Date:__________________________
Requested By
Location
Reason
Encounter #
Date-of-Service
Comment/Note
1. 2. 3.
PTL Name:______________________________ I have reviewed the charts/encounters listed above and have confirmed that all relevant information has been recreated and/or moved to the correct chart. I authorize IT to delete the erroneous encounter(s) listed above from the incorrect chart. PTL Signature:______________________________ Date:__________________
For IT Use Only Reviewed By
Ticket #
Comment
Deleted By
Ticket #
Comment
