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Medical Arts Press® Dental Registration and Medical History Form; Spanish

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Item #: 901-20586
  Model #: 20586
Brand: Medical Arts Press
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Medical Arts Press® Dental Registration and Medical History Form; Spanish
$31.50 Pack
250 EACH = 1 PACK
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Qty 1 2-3 4-7 8+
Price $41.50 $37.50 $34.50 $31.50
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Price per each: $0.17 $0.15 $0.14 $0.13
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Product Highlights
  • Form Type: Clinical
  • Format: Patient Registration Form
  • Sheet Size: 8-1/2" x 11"
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Description
Obtains a medical history and personal, financial and insurance info. Has special sections for Parent info., insurance authorization, and 2 Medical History Updates. Printed in Spanish on 20-lb. bond. 250 sheets per package. Size: 8-1/2x11".
Specifications
Form Type : Clinical Format : Patient Registration Form Sheet Size : 8-1/2" x 11" Form Size : 8-1/2" x 11"
Media Quantity : 250 Binding Type : Loose Paper Color : White Number of Parts : 1
Carbonless : No # Up Per Sheet/Page : 1 NCR Paper : No Numbered : No
Holes Punched : None Personalization : No Security Features : No Brand : Medical Arts Press
Weight : 2.53 lbs. per Pack

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