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Medical Arts Press® Chiropractic Registration and History Form; Spine
Item #: 901-20589
Model #: 20589RL
Brand: Medical Arts Press
Buy more & save!
| Qty | 1 | 2-3 | 4-7 | 8+ |
| Price | $53.99 | $49.99 | $44.99 | $41.99 |
| Qty. Savings | 7% | 16% | 22% | |
| Price per each: | $0.22 | $0.20 | $0.18 | $0.17 |
Lifetime Warranty
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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 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
- 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
| Brand : Medical Arts Press | Chart and Form Type : Standard Patient Registration Form | Charts Paper Weight (Lbs) : 24 | Color Family : Multicolor |
| Customizable : No | Height in Inches : 11" | Number of Pages : 250 | Paper Type : Bond |
| Series or Collection : Chiropractic | Speciality Use : Chiropractic | True Color : Multicolor | Used For : Registration and History Form |
| Width in Inches : 8.5" | |||
| Weight : 34.00 lbs. per Pack |
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