Medical Arts Press® Insurance Assignment Release Pad
Item #:
901-24223
Model #:
24223
Brand:
Medical Arts Press
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$6.79
5+ pad
Order in multiples of 5
1 PAD = 1 HUNDREDS
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Medical Arts Press® Insurance Assignment Release Pad
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Description
Form specifies patient insurance coverage and authorizes assignment of payment to your practice. States patient accepts responsibility for charges. Authorizes use of signature on insurance submissions and release of health care information to designated insurance carriers. Personalization includes your name, address and phone number.
- Pad size: 4x5-1/2"
- 5 pads per pack.
Specifications
Brand
Medical Arts Press
Series or Collection
Release Pad