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Item # 901-927
Quill Brand
Aluminum
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Beige
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Medical Arts Press® Tamper-Resistant Laser Rx Paper; 1 RX Blank/Sheet, High Security, 500/Pack
Item #: 901-83405
Security features exceed industry guidelines and meet all Medicaid requirements
Void pantograph - the word "VOID" appears when form is photocopied
Chemical protection - stains or spots appear with chemical alteration
Tabbies Patient Privacy Sign-In Sheets, 2-Part, 125/Pack (TAB14530)
Item #: 901-2678550
Confidentially sign in your patients with guest-check forms
Business-form size: 11.63"L x 8.5"W
2 Part Carbon
$73.99
Per pack
Solid Color Laser Statements, Style D, without Credit Card Information, Blue
Item #: 901-30465A
Solid Color Style D Laser Statements
Size: 8.5 X 11 inch
500/Package
$40.99
Per pack
Medical Arts Press® Replacement Day Sheet Forms; Bond, Format S1, 50 Forms/Pack (WJM11)
Item #: 901-20527
Replacement day sheet forms
Number of parts: One
50/Pack
$36.99
2+ pack
Staples® Record Book, Black, 300 Sheets/Book (217919)
Item #: 901-217919
Record book for keeping track of tons of information
Black cover with burgundy spine and corners features gold-stamped title for elegant look
Contains 300 numbered pages, faintly ruled with margin lines, 40 lines per page
$36.99
1-3 each
Save 2%
$35.99
4+ each
Medical Arts Press® Pet Treatment Records, Canine, No Punch
Item #: 901-20562NP
Type of form: Treatment record
250 per pack
Size: 8 1/2" x 11"
$55.99
1-4 pack
Save 3%
$53.99
5+ pack
Medical Arts Press® Treatment Notes, Tooth #, Non-Imprinted, No Punch
Item #: 901-20560NP
Type of form: Treatment note
250 per pack
Size: 8 1/2" x 11"
$49.99
1-3 pack
Save 4%
$47.99
4+ pack
ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Box of 1,000 (CMS12LC1)
Item #: 901-CMS12LC1
Includes QR code identifier at the top of the form that supports and aligns with Industry scanning systems
Printed with OCR "dropout" red ink on 20lb. paper (per government regulations)
Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
$67.99
Per carton
Quill Brand® Special-Size 3 Part Carbonless Forms, 9-1/2x5-1/2", 1,000/CT (9353)
Item #: 901-710837
Use Quill Brand special-size multi-part carbonless forms when you need multiple copies of the same form
Size: 9-1/2x5-1/2"; 8-1/2x5-1/2" without the carrier strips
3-part forms: white top sheet, canary-colored second sheet and pink third sheet
$139.99
Per carton
Medical Arts Press® Chiropractic Registration and History Form
Item #: 901-21701
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
$62.99
1-3 pack
Save 3%
$60.99
4+ pack
ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Box of 2,500 (CMS12LC)
Item #: 901-125557
Includes QR code identifier at the top of the form that supports and aligns with Industry scanning systems
Printed with OCR "dropout" red ink on 20lb. paper (per government regulations)
Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
$111.99
Per pack
Staples Columnar Books, 100 Pages, Green, 2/Pack (217844ABF)
Item #: 901-217844
Columnar book is ideal for accounting and record keeping
Eye-ease green-tinted paper
Includes 100 single-format pages with 4 columns
$19.59
1-3 pack
Save 3%
$18.99
4+ pack
New Customers
Quill® Economy Columnar Pads for Prong Fasteners; 4 Columns
Item #: 901-745804
20-lb. ledger green paper
50 numbered lines, every fifth horizontal line heavily ruled as line guide
10,000,000 units per column
$68.99
Per pack
Adams 3-Part Carbonless Receipt Book, 10.88" x 7.63", 100 Sets/Book (TC1182)
Item #: 901-TC1182
Carbonless soft-cover money/receipt books for general receipts
Originals are white in color and copies are canary and pink in color and made of smooth carbonless paper for convenience
Contains one 100-receipt book per pack
$17.59
1-4 each
Save 4%
$16.79
5+ each
Medical Arts Press® Dental Registration and History Form; Tooth Border
Item #: 901-20596
HIPAA compliant insurance authorization
Help ensure reimbursement and improve risk management
Collects printed name and relationship to patient
$53.99
1-3 pack
Save 3%
$51.99
4+ pack
Medical Arts Press® Dental Registration Forms Featuring Updates Section, Unpunched, Sky Blue
Item #: 901-20558NP
Type of form: Dental registration form
250 per pack
Size: 8 1/2" x 11"
$55.99
1-3 pack
Save 3%
$53.99
4+ pack
Quill® Economy Columnar Pads for Prong Fasteners; 6 Columns
Item #: 901-745806
20-lb. ledger green paper
10,000,000 units per column
6 columns; Description Column is 1-7/8" wide
$81.99
Per pack
Adams® Carbonless Receipt Book, 3" x 8", 2-Part, 200 Sets/Book (SC1182)
Item #: 901-SC1182
Rent receipt books for recording monthly financial payments
Carbonless paper creates white originals and canary duplicates
Four forms per page and 50 pages; 200 forms per book
$13.49
1-3 each
Save 2%
$13.09
4+ each
Tabbies 3-Part Patient Sign-in Label Forms, 125/Pack (14532)
Item #: 901-2678548
Patient sign-in label forms to sign in your patients confidentially
Form consists of three parts: a label sheet, a carbon sheet, and a log behind it
125 sheets per package
$82.99
Per pack
Adams 2-Part Carbonless Receipt Book, 5" x 11", 200 Sets/Book (SC1152)
Item #: 901-SC1152
Money/rent receipt book for recording rent payments and other payments
White originals and canary duplicates and made of carbonless paper
Contains 200 receipts per book; four forms per page
$11.29
1-4 each
Save 6%
$10.59
5+ each
Medical Arts Press® Veterinary Animal Record Progress Notes, Narrow Ruled
Item #: 901-20475
Type of form: Veterinary progress note
250 per pack
Size: 8 1/2" x 11"
$40.99
1-3 pack
Save 14%
$34.99
4+ pack
ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
Item #: 901-CMS12LC250
Approved by the National Uniform Claim Committee (NUCC); HIPAA compliant
This form was revised to align the paper form with some of the changes in the electronic healthcare claims: Professional (837), 005010X222 Technical Report Type 3 (5010) and 005010X222A1 Technical Report Type 3 (5010A1)
The most significant change was the addition of 8 diagnosis codes in field 21
$39.99
Per box