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Medical Arts Press® Chiropractic Registration and History Form; Hand

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Item #: 901-15159
  Model #: 15159
Brand: Medical Arts Press
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Medical Arts Press® Chiropractic Registration and History Form; Hand
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Qty 1 2-3 4-7 8+
Price $68.99 $63.99 $59.99 $56.99
Qty. Savings 7% 13% 17%
Price per each: $0.28 $0.26 $0.24 $0.23
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Description
  • Improved forms ensure reimbursement, improve risk management and document your clinical process
  • Comprehensive color forms include areas for complete registration and history information, reason for visit, type of pain, site of pain or numbness
  • Also features areas for severity, onset, effect on daily activities, and co
  • HIPAA-compliant insurance authorization
  • Accident information alerts to different reimbursement source
  • Check box for minors and space for school information
  • Check box for patients in non-married relationships
  • Flexible patient ID number accommodates social security number, your patient ID system, or health insurance claim number
  • Occupation, employer name, address and phone; emergency and pharmacy contacts
  • Printed on 24lb. stock, 125 forms per package, size: 8-1/2x11"
Specifications
Width in Inches : 8.5 Envelopes : Envelopes Not Included True Color : White Business Forms Pack Size : 125
Brand : Medical Arts Press Customizable : No
Weight : 3.80 lbs. per Pack

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