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Page 22 of hcfa cms 1500 health insurance business forms

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Medical Arts Press® Duplicate Rx Books; Alter-Proof, Horizontal
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Medical Arts Press® Duplicate Rx Books; Alter-Proof, Horizontal
Item #: 901-16024
(9)
Item #: 901-16024
Tamper-resistant Rx pad features 5 security features; meets October 1st 2008 Medicaid Requirements
Alter-proof blue pattern background to ensure there are no erasures or modifications of information
Void Pantograph — the word "void" will appear when photocopied
See details
Free delivery w/ $25+
Custom Referral for Treatment Slips, 4 x 5-1/2, 100 Sheets per Pad
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Custom Referral for Treatment Slips, 4" x 5-1/2", 100 Sheets per Pad
Item #: 901-QFN132181R
Item #: 901-QFN132181R
Pricing details
Referral forms for physicians
4" W x 5-1/2" L
White 20# text stock; printed in black ink
$8.59
5-9 pad
($0.09/EACH)
Save 49%
$4.39
40+ pad
($0.04/EACH)
Customize
Earn 42 points
Free delivery w/ $25+
Rediform 3-Part Carbonless Purchase Order, 8 1/2 x 11, 50 Sets/Book (1L147)
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Rediform 3-Part Carbonless Purchase Order, 8 1/2" x 11", 50 Sets/Book (1L147)
Item #: 901-65084
Item #: 901-65084
Purchase order forms come in a manifold book and are carbonless with blue print
Consecutively numbered in red
Three-Part forms
$51.69
1-2 each
Save 19%
$41.79
3+ each
Add to cart
Earn 51 points
Free delivery
Custom Proposals, Classic Design, Large Format, 3 Parts, 1 Color Printing, 8 1/2 X 11 ,250/Pack
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Custom Proposals, Classic Design, Large Format, 3 Parts, 1 Color Printing, 8 1/2" X 11" ,250/Pack
Item #: 901-D1183
Item #: 901-D1183
Pricing details
Customer sign-off line & professionally worded disclaimer prevent misunderstandings about acceptance & terms of proposal
Consecutively numbered for easy recordkeeping
Promote your business: Personalization includes your imprint plus choice of typeface and standard logo or custom logo
$329.99
1 pack
($1.32/EACH)
Save 42%
$190.99
8 pack
($0.76/EACH)
Customize
Earn 329 points
Free delivery
Custom Work Orders, Side-Stub, Carbonless, Large Format, 3 Parts, 1 Color Printing, 11 X 8 1/2 ,250/Pack
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Custom Work Orders, Side-Stub, Carbonless, Large Format, 3 Parts, 1 Color Printing, 11" X 8 1/2" ,250/Pack
Item #: 901-D65453
Item #: 901-D65453
Pricing details
Perforated invoice detaches from materials list
31 lines for material costs, plus 16 lines for work & labor descriptions
Last part is durable tag stock, useful for tracking jobs & calculating profit.
$324.99
1 pack
($1.30/EACH)
Save 42%
$187.99
16 pack
($0.75/EACH)
Customize
Earn 324 points
Free delivery
Custom Service Stations Sales Books 2 Parts, 1 Color Printing, 3 3/8 x 5 1/8, 1000/Pack
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Custom Service Stations Sales Books 2 Parts, 1 Color Printing, 3 3/8" x 5 1/8", 1000/Pack
Item #: 901-D512
(1)
Item #: 901-D512
Pricing details
Take complete orders: Preprinted areas simplify write-ups of customer information, salesperson, description of items, payment method & more
Get the details: 9 lines enable even the biggest orders to fit on a single page
Stay organized: Bottom copy stays bound in book for a permanent record
$219.99
1 pack
($0.22/EACH)
Save 50%
$108.99
8 pack
($0.11/EACH)
Customize
Earn 219 points
Free delivery
Adams Time Sheets, 100/Pad, 2 Pads/Pack (ABF 9507ABF)
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Adams Time Sheets, 100/Pad, 2 Pads/Pack (ABF 9507ABF)
Item #: 901-124495
(35)
Item #: 901-124495
Track weekly time, including morning, afternoon, and overtime using these time sheets
Number of parts: 1
Contains 100 sheets per pad, two pads per package
$9.99
Per pack
Add to cart
Earn 9 points
Free delivery w/ $25+
Custom Classic, Compact Invoices 3 Parts, 1 Color Printing, 5 2/3 x 7, 500/Pack
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Custom Classic, Compact Invoices 3 Parts, 1 Color Printing, 5 2/3" x 7", 500/Pack
Item #: 901-D1143
Item #: 901-D1143
Pricing details
Compact, yet there's room to include all the information your customers need to pay promptly
Compact invoices are ideal for smaller orders
Consecutive numbering: These forms come with the option to have consecutive numbering printed on them
$298.99
1 pack
($0.60/EACH)
Save 63%
$110.99
8 pack
($0.22/EACH)
Customize
Earn 298 points
Free delivery
Custom Progress Notes, 8-1/2 x 11, 24# White Stock, 250 Sheets per PackCustom Progress Notes, 8-1/2 x 11, 24# White Stock, 250 Sheets per Pack
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Custom Progress Notes, 8-1/2" x 11", 24# White Stock, 250 Sheets per Pack
Item #: 901-QFW2054101
Item #: 901-QFW2054101
Pricing details
For use in patient charts and files
8-1/2" W x 11" L
White 24# ledger stock, pre-printed in black ink
$17.99
1 pack
($0.07/EACH)
Save 19%
$14.49
20+ pack
($0.06/EACH)
Customize
Earn 17 points
Free delivery w/ $25+
ComplyRight™ HIPAA Notice of Privacy Practices Poster (A2123)
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ComplyRight™ HIPAA Notice of Privacy Practices Poster (A2123)
Item #: 901-728245
(5)
Item #: 901-728245
Communicates mandatory HIPAA rules to patients
Laminated
Informs patients of their rights and responsibilities under HIPAA regulations
$40.99
Per each
Add to cart
Earn 40 points
Free delivery
Medical Arts Press® Single Copy Rx Blanks, Horizontal, Alter-Proof
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Medical Arts Press® Single Copy Rx Blanks, Horizontal, Alter-Proof
Item #: 901-16035
(21)
Item #: 901-16035
Tamper-resistant Rx pad features 5 security features
Alter-proof blue pattern background to ensure there are no erasures or modifications of information - look and regulations may vary state to state
Void Pantograph — the word "void" will appear when photocopied
See details
Free delivery w/ $25+
Medical Arts Press® Tamper-Resistant Secure Rx/2-Part Carbonless
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Medical Arts Press® Tamper-Resistant Secure Rx/2-Part Carbonless
Item #: 901-13377
(25)
Item #: 901-13377
Verification Box - Hold marked area between thumb and forefinger, or breathe on heat-sensitive box, the color will disappear, then reappear
Coin Reactant Ink - Rub the Rx mark on left with a coin. Ink will turn from white to gray
MicroPrint - The right and left side rules of the large box on the front have the word "security" in microPrint. Can be viewed with magnifying glass
See details
Free delivery w/ $25+
Medical Arts Press® Rx Blanks; Single Copy, Horizontal, 5-1/2x4
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Medical Arts Press® Rx Blanks; Single Copy, Horizontal, 5-1/2x4"
Item #: 901-16010MAP
(10)
Item #: 901-16010MAP
Blanks can be imprinted with doctor's name and feature standard refill instructions
Please specify State License and/or DEA numbers if desired
Numbering available
See details
Free delivery w/ $25+
Custom Classic Large Sales Orders, 3 Parts, 1 Color Printing, 8 1/2 X 11 ,500/Pack
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Custom Classic Large Sales Orders, 3 Parts, 1 Color Printing, 8 1/2" X 11" ,500/Pack
Item #: 901-D533
Item #: 901-D533
Pricing details
Extra long, record up to 27 items
Consecutively numbered for easy recordkeeping
Promote your business: Personalization includes your imprint plus choice of typeface and standard logo or custom logo
$487.99
1 pack
($0.98/EACH)
Save 42%
$281.99
8 pack
($0.56/EACH)
Customize
Earn 487 points
Free delivery
Custom Additional Work Authorizations, 3 Parts, 1 Color Printing, 8 1/2 X 11 ,250/Pack
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Custom Additional Work Authorizations, 3 Parts, 1 Color Printing, 8 1/2" X 11" ,250/Pack
Item #: 901-D1203
Item #: 901-D1203
Pricing details
Authorized signature line included
Consecutively numbered for easy recordkeeping
Promote your business: Personalization includes your imprint plus choice of typeface and standard logo or custom logo
$381.99
1 pack
($1.53/EACH)
Save 51%
$187.99
8 pack
($0.75/EACH)
Customize
Earn 381 points
Free delivery
Custom Return to School / Work Slips, 5-1/2 x 8-1/2, 100 Sheets per PadCustom Return to School / Work Slips, 5-1/2 x 8-1/2, 100 Sheets per Pad
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Custom Return to School / Work Slips, 5-1/2" x 8-1/2", 100 Sheets per Pad
Item #: 901-QFN131411R
Item #: 901-QFN131411R
Pricing details
Return to work or school forms
5-1/2" W x 8-1/2" L
White 20# text stock; printed in black ink
$16.29
5-9 pad
($0.16/EACH)
Save 41%
$9.59
40+ pad
($0.10/EACH)
Customize
Earn 81 points
Free delivery w/ $25+
Custom 1-Sided Pegboard Account Cards, 5-1/2 x 8-1/2, 26# Coated Back Ledger Sheet, 500 Cards per
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Custom 1-Sided Pegboard Account Cards, 5-1/2" x 8-1/2", 26# Coated Back Ledger Sheet, 500 Cards per Pack
Item #: 901-QFN101XX1R
(6)
Item #: 901-QFN101XX1R
Pricing details
For use with a pegboard system
5-1/2" W x 8-1/2" L
Comes in white colored 26# coated back ledger stock, printed in black ink
$115.99
1 pack
($0.23/EACH)
Save 33%
$77.99
20+ pack
($0.16/EACH)
Customize
Earn 115 points
Free delivery
Medical Arts Press® Financial Agreement and Insurance Assignment; 4x5-1/2 Bond Non-Personalized
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Medical Arts Press® Financial Agreement and Insurance Assignment; 4x5-1/2" Bond Non-Personalized
Item #: 901-33404
Item #: 901-33404
100 sheets per pad
Pad size: 4 x 5-1/2 inches
$8.29
5+ pad
Add to cart
Earn 41 points
Free delivery w/ $25+
ComplyRight™ Employee Records Folder, Letter Size, Pack of 25 (A5001)ComplyRight™ Employee Records Folder, Letter Size, Pack of 25 (A5001)
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ComplyRight™ Employee Records Folder, Letter Size, Pack of 25 (A5001)
Item #: 901-1949184
(1)
Item #: 901-1949184
Made in the U.S.A of thick, long-lasting manila card stock
Developed by Employment Attorneys for 100% Compliance
Easily fits into any filing cabinet or desk drawer
$101.99
1-2 each
Save 9%
$92.99
3+ each
Add to cart
Earn 101 points
Free delivery
Custom Continuation Notes, 8-1/2 x 11, 500 Sheets per PackCustom Continuation Notes, 8-1/2 x 11, 500 Sheets per Pack
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Custom Continuation Notes, 8-1/2" x 11", 500 Sheets per Pack
Item #: 901-QFW2013X01
Item #: 901-QFW2013X01
Pricing details
For use in patient charts and files
8-1/2" W x 11" L
60# text stock, pre-printed in black ink; available in pink, yellow, green, and blue for setting up a color-coding system
$19.29
1 pack
($0.04/EACH)
Save 18%
$15.79
20+ pack
($0.03/EACH)
Customize
Earn 19 points
Free delivery w/ $25+
Custom Classic Design, Large Format Shipping Invoices,3 Parts, 1 Color Printing, 8 1/2 x 11, 500/Pack
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Custom Classic Design, Large Format Shipping Invoices,3 Parts, 1 Color Printing, 8 1/2" x 11", 500/Pack
Item #: 901-D1063
Item #: 901-D1063
Pricing details
Generous description area: 22 description lines
Convenient snapset format
Create clean records: Carbonless forms stay tightly aligned for clear, clean copies
$299.99
1 pack
($0.60/EACH)
Save 33%
$199.99
4 pack
($0.40/EACH)
Customize
Earn 299 points
Free delivery
Custom Service Orders, HVAC, Large Format, 4 Parts, 1 Color Printing, 8 1/2 X 11 ,500/Pack
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Custom Service Orders, HVAC, Large Format, 4 Parts, 1 Color Printing, 8 1/2" X 11" ,500/Pack
Item #: 901-D65324
Item #: 901-D65324
Pricing details
EPA checklist ensures you're in compliance with regulations on every job
Last part is durable tag stock, useful for tracking jobs & calculating profit.
Track customer acceptance: Signature line for customer authorization prevents disputes
$650.99
1 pack
($1.30/EACH)
Save 42%
$376.99
8 pack
($0.75/EACH)
Customize
Earn 650 points
Free delivery
Custom Work Orders, Carbon, Large Format, 3 Parts, 1 Color Printing, 8 1/2 X 11 ,500/Pack
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Custom Work Orders, Carbon, Large Format, 3 Parts, 1 Color Printing, 8 1/2" X 11" ,500/Pack
Item #: 901-D2443
Item #: 901-D2443
Pricing details
Last part is durable tag stock.
Consecutively numbered for easy recordkeeping
Promote your business: Personalization includes your imprint plus choice of typeface and standard logo or custom logo
$518.99
1 pack
($1.04/EACH)
Save 42%
$299.99
8 pack
($0.60/EACH)
Customize
Earn 518 points
Free delivery
Out of stock
Medical Arts Press® Continuation Notes, White, No Punch Option
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Medical Arts Press® Continuation Notes, White, No Punch Option
Item #: 901-20131NP
(1)
Item #: 901-20131NP
Type of form: Continuation note
500 per pack
Size: 8 1/2" x 11"
$64.89
1-3 pack
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