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Medical Arts Press® Chiropractic Registration and History Form; Spine

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Item #: 901-20589
  Model #: 20589RL
Brand: Medical Arts Press
Medical Arts Press® Chiropractic Registration and History Form; Spine
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Qty 1 2-3 4-7 8+
Price $48.99 $44.99 $40.99 $37.99
Save 8% 16% 22%
Price per each: $0.20 $0.18 $0.16 $0.15
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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
Weight : 3.10 lbs. per Pack

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