Medical Arts Press® Chiropractic Registration and History Form, 250 Forms/Pack (21701)
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$41.15
$82.29
Per pack
(
$0.16/EACH
)
Medical Arts Press® Chiropractic Registration and History Form, 250 Forms/Pack (21701)
Item #:
021-21701
Model #:
21701
Brand:
Medical Arts Press
4.5
(2 reviews)
Item #:
021-21701
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$41.15
Per pack
$0.16/EACH
1 PACK = 250 EACH
Medical Arts Press® Chiropractic Registration and History Form, 250 Forms/Pack (21701)
Frequently bought together
+
+
Total
$132.02
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: Size: 8-1/2x11"; Full color, Printed 2 sides on 24 lb. stock
- Sold 250 forms per pack
Specifications
Brand
Medical Arts Press
Form Size
8 1/2" x 11"
Length in Inches
11
True Color
White
Width in Inches
8.5
