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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
($0.08/EACH)
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
($0.61/EACH)
Save 8%
$69.99
4+ pack
($0.56/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
Medical Arts Press® Copy-Proof Rx Blanks, Single Sheet Pads
Item #: 901-16015
6 security features comply with CMS 10/1/08 Tamper Resistant Requirements for Medicaid
Copy-proof Rx blanks feature a blue pattern background; "void" pantograph appears when copied
Micro-print signature line helps prevent counterfeiting and states security when viewed through a magnifying glass; security band lists security features
Medical Arts Press Invoices, 8-1/2" x 11", 500 Sets/Book, 500/Pack (30465A)
Item #: 901-30465A
Solid Color Style D Laser Statements
Size: 8.5 X 11 inch
500/Package
$45.69
1-4 pack
($0.09/EACH)
Save 5%
$42.99
5+ pack
($0.09/EACH)
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
$18.89
Per each
Medical Arts Press Registration Forms without Updates Section ; Brush Silhouette
Item #: 901-21786
Comprehensive form gathers complete insurance information, making it easier for you to process claims
Silhouetted toothbrush design welcomes patients
Printed in 1-color on two sides on 24-lb. white bond paper
$56.29
Per pack
($0.23/EACH)
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
$120.09
Per pack
($0.05/EACH)
Medical Arts Press Replacement Day Sheet Forms; Bond, Format S1 (WJM11)
Item #: 901-20527
Replacement day sheet forms
Number of parts: One
50/Pack
$45.69
2+ pack
($0.91/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
$79.09
Per 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
$12.29
1-4 each
Save 10%
$10.99
5+ each
Medical Arts Press® Copy-Proof Rx Blanks; Carbonless Duplicate Books
Item #: 901-16019
6 security features comply with CMS 10/1/08 Tamper Resistant Requirements for Medicaid
Copy-proof Rx blanks feature a blue pattern background; "void" pantograph appears when copied
Micro-print signature line helps prevent counterfeiting and states security when viewed through a magnifying glass; security band lists security features
New Customers
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
$52.99
Per pack
($0.21/EACH)
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
$43.59
Per box
($0.17/EACH)
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
$84.99
1-3 pack
($8.50/EACH)
Save 18%
$68.99
4+ pack
($6.90/EACH)
Medical Arts Press Invoices, 8-1/2" x 11", 500 Sets/Book, 500/Pack (30471C)
Item #: 901-30471C
Light Purple 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
$48.99
Per pack
($0.10/EACH)
Staples Record Book, 7.25" x 11.75", Black/Burgundy (ST26513)
Item #: 901-217687
Keep records, create lists, and write other notes with this classic-look journal
Black hardcover with a burgundy spine and corners
Contains 150 numbered, wide ruled 7.25"W x 11.75"H pages, while blue and red lines make it easy to keep writing organized on each sheet
$25.49
Per each
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
($0.69/EACH)
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
($0.10/EACH)
Medical Arts Press Dental Registration Forms, 250/Pack (20558)
Item #: 901-20558NP
Type of form: Dental registration form
250 per pack
Size: 8 1/2" x 11"
$60.49
Per pack
($0.24/EACH)
Relizon Chargeable Time Control Journal, 20 Sets/Pack (WCTS4)
Item #: 901-WCTS4
Not imprintable
25 preshingles slips/journal sheet
Used with a portable binder
$151.89
1-5 box
($0.30/EACH)
Save 19%
$122.99
6+ box
($0.25/EACH)
Medical Arts Press® Tamper-Resistant Laser Rx Paper; 4 RX Blanks/Sheet, High Security
Item #: 901-83406
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
Medical Arts Press Invoices, 8-1/2" x 11", 500 Sets/Book, 505/Pack (30471D)
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
$48.89
Per pack
($0.10/EACH)
