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Medical Arts Press® Chiropractic Registration and History Form; Palm Tree

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Item #: 901-15155
  Model #: 15155
Brand: Medical Arts Press
Medical Arts Press® Chiropractic Registration and History Form; Palm Tree
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Description
  • 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 includes areas for onset, effect on daily activities, and conditions
  • HIPAA-compliant insurance authorization
  • Accident information alerts to different reimbursement source
  • Check box for minors and space for school information
  • 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
  • Size: 8-1/2x11"; full color, printed 2 sides on 24lb. stock
  • Sold 250 forms per pack
Specifications
Business Forms Pack Size : 250 Envelopes : Envelopes Not Included True Color : White Width in Inches : 8.5
Brand : Medical Arts Press
Weight : 3.80 lbs. per Pack

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