Page 15 of hcfa cms 1500 health insurance business forms
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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 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 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
ComplyRight™ 50-State Job Application (Long Form), Pack of 50 (A0019)
Item #: 901-1949613
Written by Employment Attorneys to ensure compliance in all 50 states
Gathers the maximum amount of information and exposes “red flags” without crossing into illegal territory
Includes tip sheet with HR best practices and compliance guidelines
$70.99
Per each
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 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 Carbonless 2-Part Dental Diagnosis and Estimate Forms, 8-1/2" x 11", 250 Sheets per Pack
Item #: 901-QFN102621R
For use in providing estimates and treatment plans
8-1/2" W x 11" L
2-part, white/canary, carbonless; printed in black ink
Custom 1-Sided Insurance Registration Forms, 8-1/2" x 11", 250 Sheets per Pack
Item #: 901-QFN105011R
For use in patient charts
8-1/2" W x 11" L
White 20# text stock; printed in black ink
Custom Carbonless Veterinarian Surgical Consent Form, 5-1/2" x 8-1/2", 100 Sets per Pad
Item #: 901-QFW1302901
Self-duplicating; everything is printed on original and duplicate
5-1/2" W x 8-1/2" L
White self-duplicating carbonless stock; pre-printed in black ink
Custom HIPAA Privacy Practice Acknowledgment Forms, 8-1/2" x 11", 200 Sheets per Pack
Item #: 901-QFN155811R
For use in patient charts
8-1/2" W x 11" L
White 20# text stock; printed in black ink
Custom 1-Sided Patient Registration FormFamily™ Sheets, 8-1/2" x 11", 2-Hole Top Punched, 250 Sheets per Pack
Item #: 901-QFN103771R
For use in patient charts
8-1/2" W x 11" L
White 20# text stock; printed in teal ink
Custom Chiropractic Informed Consent Forms, 8-1/2" x 11", 250 Sheets per Pack
Item #: 901-QFN105101R
Use to provide costs and services to patients
8-1/2" W x 11" L
White 20# text stock; printed in black ink
Custom Carbonless Anesthesia Consent Form, 3-1/4" x 5", 100 Sheets per Pad
Item #: 901-QFW1056501
Self-duplicating; everything is printed on original and duplicate
3-1/4" W x 5" L
White self-duplicating carbonless stock; pre-printed in black ink
TFP UB-04 CMS-1450 1-Part Health Insurance Claims, 2500/Carton (UB04LC)
Item #: 901-519727
Designed for hospitals to file a medical claim with the patient's insurance carrier
One-part health insurance forms
Contains 2500 forms per carton
$118.89
Per carton
($0.05/EACH)
Custom Minor/Child Consent Form Slips, 5-1/2" x 4", 100 Sheets per Pad
Item #: 901-QFN134XX1R
For consent to provide treatment to a minor or child
5-1/2" W x 4" L
White 20# text stock; printed in black ink
Custom Dental After-Treatment Instruction Forms, 8-1/2" x 11", 100 Sheets per Pad
Item #: 901-QFN105611R
Use for patient care instructions
8-1/2" W x 11" L
White 20# text stock; printed in black ink
Custom Carbonless 2-Part Certificate of Professional Care Forms, 4" x 5-1/2", 50 Sets per pad
Item #: 901-QFN131121R
For certification of care
4" W x 5-1/2" L
2-part, white/canary, carbonless; printed in black ink
Custom Carbonless 2-Part Examination Report Forms, 4" x 5-1/2", 50 Sets per Pad
Item #: 901-QFN131141R
Use to provide costs and services to patients and for use in patient charts
4" W x 5-1/2" L
2-part, white/canary, carbonless; printed in black ink
Sof-Form® Non-sterile Conforming Gauze Bandages; 75" L x 2" W, 96/Pack
Item #: 901-113612MED
Rayon/Polyester Material
Non-sterile
Latex-free
$22.59
Per carton
ComplyRight CMS-1500 Jumbo Health Care Billing Envelope, 500/Pack (1500LR500)
Item #: 901-24581404
This CMS-1500 jumbo health care billing envelope helps reduce processing delays
500 envelopes per box
Form size: 9" x 12.5"
$150.79
Per each
TOPS™ Perforated Guest Check Pad, 1-Part, 50 Sheets/Pad (525SW)
Item #: 901-196287
Perforated Guest Check Pads to keep track of messages, finances, transactions, employees and taxes
Dimensions: 3"H x 3.4"W x 6.75"L, 6.25" x 3.4" (detached form), 6.75" x 3.4" (sheet)
Color: White (primary page), green (ink)
$9.39
Per pack
Business Checks & Custom Forms
Item #: 901-BCCF
Personal and business checks with an extensive selection of designs, features and related products
The latest in proven security and anti-fraud features to deter check alteration and enable check authentication
The latest in proven security and anti-fraud features to deter check alteration and enable check authentication
$108.99
1 each
Save 29%
$76.99
8+ each
TOPS Job 3-Part Carbonless Work Orders, 8.62"L x 5.67"W, 50 Sets/Book (3868)
Item #: 901-3868
Job work-order forms designed to provide a space for work, costs, and totals
Business-form size: 8.62"L x 5.67"W
3-Part Carbonless forms for accurate record keeping
$36.09
1-4 pack
($0.72/EACH)
Save 5%
$33.99
5+ pack
($0.68/EACH)
Permatex® Form-A-Gasket® Sealants, 3 oz, tube
Item #: 901-710567ORS
Black gasket sealants for efficient sealing and bonding
3 oz. tube for convenient application
Flexible sealant can be used on non-rigid and vibrating surfaces
$194.99
Per carton
