Page 13 of hcfa cms 1500 health insurance business forms
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Custom Register Form, Classic Design, Large Format, ALL SALES FINAL, 2 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D610SW2A
Multiple layout options: Available in your choice of 3 layouts of special wording - Layout A: All Sales Final, Layout B: No Cash Returns, Layout C: Custom Message
Compatible with our registers
Consecutive numbering: These forms come with the option to have consecutive numbering printed on them
Custom Road Service Register Form, Large Format, 3 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D6133
Works with your portable register to capture details on the spot - no hunting for a handy place to write
Preprinted areas for mileage, service time, special equipment, labor & storage costs, plus much more
Signature line for customer authorization prevents disputes
Custom Multi-Purpose Register Form, Spectra Design, Large Format, 3 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-DSP1263
Compatible with our register holders
These forms come with the option to have consecutive numbering printed on them
Additional customization options include imprinting your custom logo
Cosco Notice of Privacy Practices with Label, Spanish, 8-Part, 250 Forms/Pack (074045)
Item #: 901-24643944
250 sets per pack
8-part form
Removable label for patient's folder
ComplyRight Personnel Folder, 6-Part , 25 Forms/Pack (A1175)
Item #: 901-1949186TFP
Expandable organizer offers convenient, comprehensive record-keeping
Contains six different file folders per organizer
Contains 25 organizers per package including one outer jacket and six tabbed folders each
Custom 2-Part Snapset CMS Forms, 8-1/2" x 11", 500 Sets per Pack
Item #: 901-QFW1471701
Snapset form for use by all medical facilities for billing insurance companies, Medicaid and Medicare; aligned with the electronic HIPAA ASC X12N 837 Non-institutional Transaction Standard
8-1/2" W x 11" L
2-part, white/canary, carbonless
Custom Multi-Purpose Register Form, Classic Design, Small Format, NO CASH RETURNS, 2 Parts, 1 Color Printing, 4" x 6", 500/Pack
Item #: 901-D609SW2B
Multiple layout options: Available in your choice of 3 layouts of special wording - Layout A: All Sales Final, Layout B: No Cash Returns, Layout C: Custom Message
Compatible with our registers
Consecutive numbering: These forms come with the option to have consecutive numbering printed on them
Custom Multi-Purpose Register Form, Classic Design, Small Format, 4 Parts, 1 Color Printing, 4" x 6", 500/Pack
Item #: 901-D6094
Use with your portable register to capture details on the spot - no hunting for a handy place to write
Compatible with 4 x 6" portable registers
7 lines enable most orders to fit on a single form
Custom Multi-Purpose Register Form, Spectra Design, Large Format, 2 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-DSP1262
Compatible with our register holders
These forms come with the option to have consecutive numbering printed on them
Additional customization options include imprinting your custom logo
Custom Multi-Purpose Register Form, Spectra Design, Small Format, 3 Parts, 1 Color Printing, 4" x 6", 500/Pack
Item #: 901-DSP1253
Compatible with our register holders
These forms come with the option to have consecutive numbering printed on them
Additional customization options include imprinting your custom logo
Custom Carbonless CMS Forms, 8-1/2" x 11", 100 Sheets per Pad
Item #: 901-QFW1471901
For use by all medical facilities for billing insurance companies, Medicaid and Medicare; aligned with the electronic HIPAA ASC X12N 837 Non-institutional Transaction Standard
8-1/2" W x 11" L
1-part, white, carbonless; carbon paper is required for duplicates
Custom Multi-Purpose Register Form, Classic Design, Large Format, 3 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D6103
Use with your portable register to capture details on the spot - no hunting for a handy place to write
Preprinted areas simplify write-ups of customer information, salesperson, description of items, payment method & more
Compatible with 5 1/2 x 8 1/2" portable registers, sold separately
Custom Multi-Purpose Register Form, Colors Design, Large Format, 2 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D610T2
Use with your portable register to capture details on the spot - no hunting for a handy place to write
Preprinted areas simplify write-ups of customer information, salesperson, description of items, payment method & more
Compatible with 5 1/2 x 8 1/2" portable registers, sold separately
Custom Multi-Purpose Register Form, Classic Design, Large Format, 4 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D6104
Use with your portable register to capture details on the spot - no hunting for a handy place to write
Preprinted areas simplify write-ups of customer information, salesperson, description of items, payment method & more
Compatible with 5 1/2 x 8 1/2" portable registers, sold separately
Custom Carbonless 2-Part Referral Forms, 4" x 5-1/2", 50 Sets per Pad
Item #: 901-QFN160421R
Referral forms for physicians
4" W x 5-1/2" L
2-part, white/canary, carbonless; printed in black ink
Custom Registration Forms, 8-1/2" x 11", 250 Sheets per Pack
Item #: 901-QFN105XX1R
For use in patient charts
8-1/2" W x 11" L
White 20# text stock with preprinted template; custom imprint printed in black ink
Custom 2-Part Charge Slip Forms, 8-1/2" x 11", 1000 Sets per Pack
Item #: 901-QFW1054401
For internal use in veterinary offices
8-1/2" W x 11" L
2-part, white/canary, carbonless; pre-printed in black and blue ink
ComplyRight 2026 Attendance Calendar Set, 50 Forms/Pack (A1411W16PK50)
Item #: 901-1949172TFP
Calendar format on front of Attendance Calendar Cards makes noting absences quick and easy
Simple coding system included to aid in quickly identifying troubling patterns
Back of Attendance Calendar form allows for recording absence notes, tracking leave as well as any employee warnings for attendance issues
Custom 2-Part Numbered Charge Slip Forms, 8-1/2" x 11", 1000 Sets per Pack
Item #: 901-QFW1053801
For internal use in veterinary offices
8-1/2" W x 11" L
2-part, white/canary, carbonless; pre-printed in black and blue ink
Custom Multi-Purpose Register Form, Colors Design, Large Format, 4 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D610T4
Use with your portable register to capture details on the spot - no hunting for a handy place to write
Preprinted areas simplify write-ups of customer information, salesperson, description of items, payment method & more
Compatible with 5 1/2 x 8 1/2" portable registers, sold separately
Custom Multi-Purpose Register Form, Colors Design, Small Format, 3 Parts, 1 Color Printing, 4" x 6", 500/Pack
Item #: 901-D609T3
Use with your portable register to capture details on the spot - no hunting for a handy place to write
Preprinted areas simplify write-ups of customer information, salesperson, description of items, payment method & more
Compatible with 4 x 6" portable registers, sold separately
Custom Multi Purpose Forms, Continuous, 3 Parts, 1 Color Printing, 8 1/2" x 7", 500/Pack
Item #: 901-D913163
Consecutive numbering available
Promote your business: Personalization includes your imprint plus choice of typeface and standard logo
Imprint Color: Black
Custom Dental Registration Forms, 8-1/2" x 11", 250 Sheets per Pack
Item #: 901-QFW2055801
Includes complete personal and insurance information, and assignment and release for easy account set up
8-1/2" W x 11" L
White 24# bond stock, pre-printed in black and blue ink
Custom Register Forms, Classic, Cash & Charge 2 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D158142
Die cut holes fit most standard registers
Includes personalization up to 4 lines
Imprint Color: Red
