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ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Box of 1,000 (CMS12LC1)
Item #: 901-CMS12LC1
Includes QR code identifier at the top of the form that supports and aligns with Industry scanning systems
Printed with OCR "dropout" red ink on 20lb. paper (per government regulations)
Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
$80.59
Per carton
Tabbies Patient Privacy Sign-In Sheets, 2-Part, 125/Pack (TAB14530)
Item #: 901-2678550
Confidentially sign in your patients with guest-check forms
Business-form size: 11.63"L x 8.5"W
2 Part Carbon
$76.59
1-3 pack
Save 8%
$69.99
4+ pack
Quill® Economy Columnar Pads for Prong Fasteners; 4 Columns, 50 Sheets/Pad, 10 Pads/Pack (95141)
Item #: 901-745804
20-lb. ledger green paper
50 numbered lines, every fifth horizontal line heavily ruled as line guide
10,000,000 units per column
$81.69
1-3 pack
Save 19%
$65.99
4+ pack
Adams 3-Part Carbonless Receipt Book, 10.88" x 7.63", 100 Sets/Book (TC1182)
Item #: 901-TC1182
Carbonless soft-cover money/receipt books for general receipts
Originals are white in color and copies are canary and pink in color and made of smooth carbonless paper for convenience
Contains one 100-receipt book per pack
$18.19
Per each
Medical Arts Press® Tamper-Resistant Laser Rx Paper; 1 RX Blank/Sheet, High Security, 500/Pack
Item #: 901-83405
Security features exceed industry guidelines and meet all Medicaid requirements
Void pantograph - the word "VOID" appears when form is photocopied
Chemical protection - stains or spots appear with chemical alteration
ComplyRight CMS-1500 Health Insurance Claims, 2500/Pack (CMS12LC)
Item #: 901-125557
Includes QR code identifier at the top of the form that supports and aligns with Industry scanning systems
Printed with OCR "dropout" red ink on 20lb. paper (per government regulations)
Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
$115.39
Per pack
Tabbies 3-Part Patient Sign-in Label Forms, 125/Pack (14532)
Item #: 901-2678548
Patient sign-in label forms to sign in your patients confidentially
Form consists of three parts: a label sheet, a carbon sheet, and a log behind it
125 sheets per package
$86.79
Per pack
Adams® Carbonless Receipt Book, 3" x 8", 2-Part, 200 Sets/Book (SC1182)
Item #: 901-SC1182
Rent receipt books for recording monthly financial payments
Carbonless paper creates white originals and canary duplicates
Four forms per page and 50 pages; 200 forms per book
$13.89
Per each
ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
Item #: 901-CMS12LC250
Approved by the National Uniform Claim Committee (NUCC); HIPAA compliant
This form was revised to align the paper form with some of the changes in the electronic healthcare claims: Professional (837), 005010X222 Technical Report Type 3 (5010) and 005010X222A1 Technical Report Type 3 (5010A1)
The most significant change was the addition of 8 diagnosis codes in field 21
$41.89
Per box
Solid Color Laser Statements, Style D, without Credit Card Information, Blue
Item #: 901-30465A
Solid Color Style D Laser Statements
Size: 8.5 X 11 inch
500/Package
$43.89
1-4 pack
Save 6%
$40.99
5+ pack
Adams 2-Part Carbonless Receipt Book, 5" x 11", 200 Sets/Book (SC1152)
Item #: 901-SC1152
Money/rent receipt book for recording rent payments and other payments
White originals and canary duplicates and made of carbonless paper
Contains 200 receipts per book; four forms per page
$11.79
1-4 each
Save 6%
$10.99
5+ each
Tabbies Healthcare Patient Privacy Sign-In Sheets, 11"L x 8.5"W, 125/Pack (14531)
Item #: 901-2678549
Confidentially sign in your patients with patient sign-in label forms
One-part patient sign-in label forms
Contains 125 sheets per pack for bulk purchasing
$75.99
Per pack
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Staples® Columnar Books, 100 Pages, Green, 2/Pack (217869)
Item #: 901-217869
Columnar book is ideal for accounting and record keeping
Eye-ease green-tinted paper
Includes 100 single-format pages with 6 columns
$24.49
Per pack
ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 500 (CMS12LC500)
Item #: 901-CMS12LC500
Includes QR code identifier at the top of the form that supports and aligns with Industry scanning systems
Printed with OCR "dropout" red ink on 20lb. paper (per government regulations)
Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
$49.99
Per pack
Solid Color Laser Statements; Style A, with Credit Card Information, Blue
Item #: 901-30471D
Light Blue Background on Front
Back Is White with Printed Change Of Address & Visa & Mastercard Credit Card Payment Sections
Perforation Is 3.68 From top Of Sheet
$46.99
Per pack
Medical Arts Press Dental Registration and History Form, 250/Pack (20605)
Item #: 901-20605
Form allows you to gather complete information from patients
Simple to fill out with individually numbered sections
Includes sections on patient information, insurance, history and more
$50.99
Per pack
Solid Color Laser Statements; Style A, with Credit Card Information, Teal
Item #: 901-30471A
Light Teal Background on Front
Back Is White with Printed Change Of Address & Visa & Mastercard Credit Card Payment Sections
Perforation Is 3-11/16 From top Of Sheet
$49.99
1-5 pack
Save 18%
$40.99
6+ pack
Relizon Chargeable Time Control Journal, 20 Sets/Pack (WCTS4)
Item #: 901-WCTS4
Not imprintable
25 preshingles slips/journal sheet
Used with a portable binder
$145.99
1-5 box
Save 19%
$117.99
6+ box
Rediform Texhide Record Book, 500 Pages, Black (57151)
Item #: 901-57151
Book for records and daily schedules
Black leather-like cover with burgundy spine and corners
Includes 500 numbered pages with green and brown ruling
$103.09
1-2 each
Save 19%
$82.99
3+ each
Solid Color Laser Statements, Style B, with Credit Card Information, Blue
Item #: 901-33176A
Credit Card Alert Helps Speed Payment - Visa & Mastercard only
Includes Patient Update
Easy-Tear Perforation Is 3.68" From top for Removal Of White Payment Stub
$44.89
Per pack
Adams 2-Part Carbonless Sales Orders, 8.44"L x 5.56"W, 50 Sets/Book (DC5805)
Item #: 901-196113
Sales and order books are ideal for keeping proper records of orders and sales
Business form size: 5.56"W x 8.44"L; detached: 5.56"W x 7.94"L
2-Part White/Canary Carbonless forms for accurate record keeping
$10.79
1-7 each
Save 8%
$9.89
8+ each
Medical Arts Press® Progress Notes; Reinforced, Top Punched, 250/Pack (20555)
Item #: 901-20555
Provides plenty of room to record patient progress and your findings at subsequent visits
Record patient name, birth date and gender
Ruled back side
$81.69
Per pack
Medical Arts Press® Dental Registration and History Form; Tooth Border, 250 Sheets/Pack (20596)
Item #: 901-20596
HIPAA compliant insurance authorization
Help ensure reimbursement and improve risk management
Collects printed name and relationship to patient
$55.09
Per pack
Medical Arts Press® Progress Notes, No Imprint, 250/Pack (21757NP)
Item #: 901-21757NP
Type of form: Progress note
250 per pack
Size: 8 1/2" x 11"
$46.99
Per pack
