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Item #:
901-20743
Model #:
20743
Brand:
Medical Arts Press
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250 EACH = 1 PACK
Free shipping
Description
- HIPAA-compliant insurance authorization
- Collects printed name and relationship to patient
- Medication list requests correlating diagnosis
- Screens for artificial heart valves, artificial joints, heart
- Size: 8-1/2x11"
Specifications
Brand
Medical Arts Press
Chart and Form Type
Standard Patient Registration Form
Charts Paper Weight (Lbs)
24
Color Family
Blue
Customizable
No
Height in Inches
11"
Number of Pages
250
Series or Collection
Dental
Speciality Use
Dental
True Color
Blue/White
Used For
Registration and History Form
Width in Inches
8.5"