I use a professionally printed, duplicate paper, pin fed superbill which we run off every morning on an Okidata printer. The superbill prints out with patient info derived from my PM program. My PM program actually allows me to take a pre-printed form and design my own superbill from it, pretty nifty. When the patient leaves, their copy serves as their receipt for their copay, has the date and time of their next appointment, date and times of any tests or consultant appointments, and any special instructions from me, all of which are hand-written. The original copy then goes to my in-house biller. You could scan this into their chart or into another file folder if you so desired but we simply keep them as a paper trail. They also serve as documentation that the patient was handed detailed instructions upon their departure.