Page 2 of Forms
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Medical Arts Press® Washington Laser Prescription Forms; Non Personalized
Item #: 901-26536
Security Features Include:
VOID pantograph, thermochromic ink, state seal in lower right-hand corner, microprint signature line and a watermark in opaque ink.
Medical Arts Press® Comprehensive Examination Form
Item #: 901-21700
4-page document records clinical detail from a patient's comprehensive exam
Includes sections to record results from clinical tests
Includes top 25 ortho/neuro tests
$74.49
Per pack
Medical Arts Press® Chiropractic Forms; Travel Card
Item #: 901-21704
Set Up In Popular S.O.A.P. Format of Subjective, Objective, Assessment & Plans
Allows Carryover Of Chief Complaints & Treatment
Printed On Both Sides to Track Up to 20 Visits On One Card
$38.79
1 pack
Save 7%
$35.99
2+ pack
Medical Arts Press® Dental Registration and History Form; Tooth Border, 250 Sheets/Pack (20596)
Item #: 901-20596
HIPAA compliant insurance authorization
Help ensure reimbursement and improve risk management
Collects printed name and relationship to patient
$55.09
Per pack
Medical Arts Press® Consent Form, Dental Treatment, Bilingual, 250/Pack (21153)
Item #: 901-21153
Size: 8 1/2" x 11"
Paper color: White
Number of parts: 1
$55.09
Per pack
Medical Arts Press® Welcome Registration Form, Paw Print in Middle
Item #: 901-20630
Type of form: Registration form
250 per pack
Size: 8 1/2" x 11"
$48.99
Per pack
Medical Arts Press® Dental Treatment Consent Form; 1-Sided
Item #: 901-20606
Provides your patient complete information about their treatment and its risks
Obtains written consent for your records
Just check off applicable conditions; patient reads explanation, initials and signs
$47.99
1 pack
Save 6%
$44.99
2+ pack
Medical Arts Press Dental Registration Forms Featuring Updates Section; Sky Blue, Spanish (20743)
Item #: 901-20743
Collects printed name and relationship to patient
Medication list requests correlating diagnosis
Screens for artificial heart valves, artificial joints, heart
$64.29
Per pack
Medical Arts Press Eye Care Registration Form (20571)
Item #: 901-20571
Type of form: Registration form
250 per pack
Size: 8 1/2" x 11"
$64.29
Per pack
Medical Arts Press® Podiatry Registration and History Forms, Love Your Feet
Item #: 901-15143
Features personal and insurance information sections that enable you to set up your patient s account with ease
Contains a history section to provide chief complaint, current and past symptoms and previous podiatric treatment information
Size: 8-1/2x11"
$52.09
Per pack
Medical Arts Press® Registration Form Featuring Updates Section/Blue Wave
Item #: 901-33018
HIPAA compliant insurance authorization
Help ensure reimbursement and improve risk management
Collects printed name and relationship to patient
$20.59
Per pack
Quill Brand® Special-Size 3 Part Carbonless Forms, 9-1/2x5-1/2", 1,000/CT (9353)
Item #: 901-710837
Use Quill Brand special-size multi-part carbonless forms when you need multiple copies of the same form
Size: 9-1/2x5-1/2"; 8-1/2x5-1/2" without the carrier strips
3-part forms: white top sheet, canary-colored second sheet and pink third sheet
$142.99
Per carton
Quill Brand® Special-Size Multi-Part Carbonless Forms, 9-1/2 x 5-1/2", 3200 Sheets/Carton
Item #: 901-710833
Business paper is perfect for printing receipts that require two copies
Paper dimensions: 5.5"W x 9.5"L
Paper weight: 15 lbs.
$106.99
Per carton
ComplyRight 2024 ADA Dental Claim Forms, 1,000 Forms/Pack (202411)
Item #: 901-24602227
Forms conform to the Health Insurance Portability and Accountability Act (HIPAA)
Forms provide a common format for reporting dental services to a patient's dental benefit plan
ADA policy promotes use and acceptance latest version ADA Dental Claim Forms by dentists and payers
$63.29
Per each
ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Box of 1,000 (CMS12LC1)
Item #: 901-CMS12LC1
Includes QR code identifier at the top of the form that supports and aligns with Industry scanning systems
Printed with OCR "dropout" red ink on 20lb. paper (per government regulations)
Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
$80.59
Per carton
ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 500 (CMS12LC500)
Item #: 901-CMS12LC500
Includes QR code identifier at the top of the form that supports and aligns with Industry scanning systems
Printed with OCR "dropout" red ink on 20lb. paper (per government regulations)
Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
$49.99
Per pack
TOPS Centers for Medicare and Medicaid Services Forms, 8-1/2" x 11", 250/Pack (50135RV)
Item #: 901-2408453
CMS-1500 claim forms (formerly known as HCFA-1500 claim forms) expedite Medicare, Medicaid or private insurance benefits
Top sensor bar for microfiche duplication, as required in some states
OCR red ink for scanning
$33.69
Per pack
Custom Multi-Purpose Register Form, Colors Design, Large Format, 2 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D610T2
Use with your portable register to capture details on the spot - no hunting for a handy place to write
Preprinted areas simplify write-ups of customer information, salesperson, description of items, payment method & more
Compatible with 5 1/2 x 8 1/2" portable registers, sold separately
ComplyRight 2024 ADA Dental Claim Forms, 2,500 Forms/Pack (20241)
Item #: 901-24602226
Forms conform to the Health Insurance Portability and Accountability Act (HIPAA)
Forms provide a common format for reporting dental services to a patient's dental benefit plan
ADA policy promotes use and acceptance latest version ADA Dental Claim Forms by dentists and payers
$117.39
Per each
Cosco Patient Confidential Sign-In Forms, 3-Part, 125 Forms/Pack (074039)
Item #: 901-24617595
Patient Sign-In Label forms to sign in your patients confidentially
HIPAA Compliant
125 Sheets Per Package
$122.49
1-9 pack
Save 9%
$110.99
10+ pack
Cosco Patient Confidential Sign-In Forms, 3-Part, 125 Forms/Pack (074043)
Item #: 901-24617597
Patient Sign-In Label forms to sign in your patients confidentially
HIPAA Compliant
125 Sheets Per Package
$123.49
1-5 pack
Save 19%
$98.99
6+ pack
ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)
Item #: 901-24614845
Designed for hospitals to file a medical claim with the patient's insurance carrier
One-part health insurance forms
Printed with OCR dropout red ink on white paper
$38.79
Per each
Cosco Patient Confidential Sign-In Forms, 3-Part, 125 Forms/Pack (074041)
Item #: 901-24617598
Patient Sign-In Label forms to sign in your patients confidentially
HIPAA Compliant
125 Sheets Per Package
$122.49
Per pack
TOPS 2024 1099 Tax Form, 1-Part, 2-Up, 100 Forms/Pack (LBLANKQ)
Item #: 901-5144
2024 1099 Tax Form 2 Up laser cut sheet with blank front and back with 1/2" right stub
Laser printer compatible
Printed in black ink
$22.49
Per pack
