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Medical Arts Press® Chiropractic Registration and History Form

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Item # 901-21701
  Model # 21701
Medical Arts Press® Chiropractic Registration and History Form
$43.99 Pack When you buy 4+

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Product Information
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
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