Pat Lindsey, IBCLC - Lactation Visit Receipt Packet
Sample of Forms in PDF
These are samples for customers to get an idea of what the business forms look like.
 PDF FILLABLE FORMS can be filled out on any digital device with Adobe PDF Reader.
Click Here to view
(click on LVR to see form)
(more form samples below)
The LVR Packet includes the following:
Customized Header on the ICD-10 Lactation Visit Receipt (Superbill) in PDF (with permission to print as many as you need)  Deluxe Packets also include customized PDF FILLABLE FORMS as marked below. Digital PDF fillable forms can be filled out on your computer, laptop, ipad, tablet or any electronic device with Adobe Reader then saved into a patient chart (file folder). To be HIPAA complaint your electronic files must be password protected.

A 37 page instruction guide with details on filling out the LVR & basic reimbursement information in PDF

All forms in the LVR packet (superbill and business forms) are to be used as paper forms NOT DIGITIAL forms with the exception of the digital PDF FILLABLE FORMS marked below in the Deluxe Packets. If using paper forms, they can be filled out then scanned into a folder (patient chart) in your password protected computer as an electronic record.

 BONUS FORMS - Templates of the following in WORD:


Also available in PDF FILLABLE FORM - Deluxe Packets only
Also available in PDF PDF FILLABLE FORM - Deluxe Packets only

Documentation Forms

Also available in PDF PDF FILLABLE FORM - Deluxe Packets only


Also available in PDF PDF FILLABLE FORM - Deluxe Packets only


AND,  more

2002-2015@Pat Lindsey, IBCLC - Lactation Visit Receipt