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Offer good through 7/15/22.

Medical Arts Press® Chiropractic Registration and History Form; Hand

Order Medical Arts Press® Chiropractic Registration and History Form; Hand today at Quill.com and get fast shipping. Stack coupons to get free gifts & extra discounts!
Item #: 901-15159
  Model #: 15159
Brand: Medical Arts Press
Medical Arts Press® Chiropractic Registration and History Form; Hand
$68.99 Pack
When you buy 4+
250 EACH = 1 PACK
or
$77.99 Pack
When you buy 1-3
Buy more & save!
Qty 1-3 4+
Price $77.99 $68.99
Qty. Savings 11%
Price per each: $0.31 $0.28
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Description
  • Improved 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
  • Check box for patients in non-married relationships
  • 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
  • Printed on 24lb. stock, 125 forms per package, size: 8-1/2x11"
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 : 125 Paper Type : Cardstock
Series or Collection : Chiropractic Speciality Use : Chiropractic True Color : Multicolor Used For : Registration and History Form
Width in Inches : 8.5"
Weight : 3.12 lbs. per Pack
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