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Medical Arts Press® Chiropractic Registration and History Forms, Balanced Rocks

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Item # 901-35061
  Model # 35061
Medical Arts Press® Chiropractic Registration and History Forms, Balanced Rocks
$64.99 Pack When you buy 8+

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250 EACH = 1 PACK
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Price $77.99 $71.99 $67.99 $64.99
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Description
Comprehensive forms include areas for complete registration and history information. Includes general patient information, payment and insurance information, patient condition, and health history. Improved forms ensure reimbursement and improve risk management. Document your clinical process. Documents reason for visit, type of pain, site of pain or numbness, severity, onset, effect on daily activities, and constancy and progression of symptoms. HIPAA-compliant insurance authorization. Accident information alerts to different reimbursement source. Minor check box for adolescents plus school info. 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. Ten digit phone numbers throughout. Occupation, employer name, address, phone. Emergency and pharmacy contacts. Printed 2 sides on 24 lb. stock. Sold 250 per package.
  • Type of form: Registration and history form
  • 250 per pack
  • Size: 8 1/2" x 11"
  • Paper weight: 24 lbs
  • Binding type: Loose
  • Number of parts: 1
  • Comprehensive forms include areas for complete registration and history information, includes general patient information, payment and insurance information, patient condition, and health history
  • Improved forms ensure reimbursement and improve risk management, document your clinical process
  • Documents reason for visit, type of pain, site of pain or numbness, severity, onset, effect on daily activities, and constancy and progression of symptoms
  • Accident information alerts to different reimbursement source, minor check box for adolescents plus school info
  • 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
  • Ten digit phone numbers throughout, occupation, employer name, address, phone, emergency and pharmacy contacts, printed 2 sides on 24 lbs. stock
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