Patient ledger form

This sheet is titled Patient Progress Notes and works as a paper ledger for a single patient. Each page has a line for the patient’s name and page number, then columns for the date, the treatment provided, and the charges. The file holds two copies of the layout on one page.

Use it in offices that keep paper charts, during a software outage, or for a patient whose care needs a separate running record. The clinical team writes the treatment and the front desk adds the charges, so anyone pulling the chart can see what was done and billed on each date.