Page 22 of hcfa cms 1500 health insurance business forms
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ComplyRight Orthodontic Case Analysis File, 9.5" x 11.75", 25 Folders/Pack (A1048)
Item #: 901-24433069
Safely store patient records, record key patient information, case details, and benefits with this orthodontic case analysis file
Size: 9.5" x 11.75"
Beige sheet of paper with black text
Adams Time Sheets, 100/Pad, 2 Pads/Pack (ABF 9507ABF)
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
Medical Arts Press® Tamper-Resistant Secure Rx/2-Part Carbonless
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
Rediform Snap-A-Way 3-Part Carbonless Bill of Lading, 7"L x 8.5"W, 250 Sets/Book (44301)
Item #: 901-421168
Bill of lading provides accurate contractual wording for complete documentation and is punched to allow storage in a post binder
Business form size: 7"L x 8.5"W
3-Part Carbonless forms for accurate record keeping
Custom Repair Orders, Garage, Carbon, Side-Stub, Large Format, 3 Parts, 1 Color Printing, 11" X 8 1/2" ,500/Pk
Item #: 901-D6553
27 lines for parts & accessories, plus handy odometer in/out boxes & "Save Old Parts" question box for use when scheduling maintenance
Track customer acceptance: Signature line for customer authorization prevents disputes
Consecutively numbered for easy recordkeeping
Bankers Box Liberty Corrugated File Storage Boxes, String & Button Closure, Check & Form Size, White/Blue, 12/Carton (00005)
Item #: 901-FF5
String & button, basic-duty box perfect for storing checks and forms
White/Blue corrugated storage box with standard assembly is sturdy and lightweight
Check Size, holds 10.75" x 23.27" files
Custom Work Orders, Carbonless, Small Format 2 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D2112
Custom printed business forms, with time-saving features & expert personalization
16 lines for materials, plus space for labor & other costs
Signature line for customer authorization prevents disputes
Custom Work Orders, Job, Carbon, Small Format 3 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D2583
Custom printed business forms, with time-saving features & expert personalization
Extra-large work description area, including 13 lines for detailed write-ups
Signature line for customer authorization prevents disputes
Avery 4.75" Auto Park Tags, Manila, 500/Box (18670)
Item #: 901-903184
Sequentially numbered 1 to 500 in duplicate on top and bottom coupon.
"Retain this check" is printed in red on bottom only.
Reinforced patch with strong twine.
Custom Purchase Orders, Booked, 2 Parts, 1 Color Printing, 6 3/8" x 8 1/2", 250/Pack
Item #: 901-D87T2
Get the details: Includes 12 lines for procurement items with plenty of space for terms, requisition numbers, stock & shipping information
Track customer acceptance: Signature line for customer authorization prevents disputes
Promote your business: Personalization includes your imprint plus choice of typeface and standard logo
Medical Receipt Books; Blank
Item #: 901-MRB109NI
Keep a permanent record of patient payments in chronological order
3-parts; parts one & two are perforated, part three remains in book as permanent record
Includes insert to prevent write-through
Custom Sales Slips, Classic Design, Large Format 3 Parts, 1 Color Printing, 5 2/3" x 8 1/2", 500/Pack
Item #: 901-D813
Custom printed business forms, with time-saving features & expert personalization
16 lines for writing up larger sales
Carbonless 2- or 3-part forms stay tightly aligned for clear, clean copies
Medical Arts Press® Tamper-Resistant Secure Rx Blanks; Single Sheet
Item #: 901-15970
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
Custom Small Lined Invoices, 3 Parts, 1 Color Printing, 8 1/2" x 7", 250/Pack
Item #: 901-D108T3
Get the details: Includes 13 description lines on this lined form to record the invoice details
Consecutively numbered for easy recordkeeping
Promote your business: Personalization includes your imprint plus choice of typeface and standard logo
ComplyRight™ Employee Hiring & Employment History Folder, Pack of 25 (A3310)
Item #: 901-2548997
Made in the U.S.A of thick, long-lasting manila card stock
Developed by Employment Attorneys for 100% Compliance
Ample space to store and keep employee hiring and employment records confidential
ComplyRight 2025-2026 Academic Year Attendance Calendar Cards, 50/Pack (A43005015)
Item #: 901-1949178TFP
Features an academic year calendar format (August 1 – July 31) and easy coding system
Efficient calendar format makes tracking absences quick and convenient
Reverse side includes plenty of space to record notes and warnings
Medical Arts Press® Single Copy Rx Blanks; Vertical, Alter-Proof
Item #: 901-16034
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
Custom Service Orders, Carbon, Small Format 3 Parts, 1 Color Printing, 5 2/3" x 8 1/2", 500/Pack
Item #: 901-D3073
Custom printed business forms, with time-saving features & expert personalization
Signature line for customer authorization prevents disputes
Carbon-backed sets available in 2, 3 or 4 parts
Custom Work Orders, Job, Carbonless, Small Format 2 Parts, 1 Color Printing, 5 2/3" x 8 1/2", 500/Pack
Item #: 901-D65582
Custom printed business forms, with time-saving features & expert personalization
Extra-large work description area, including 13 lines for detailed write-ups
Signature line for customer authorization prevents disputes
Custom Retail Sales Book, Classic Design, NO CASH RETURNS, 3 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D55SW3B
Take complete orders: Preprinted areas simplify write-ups of customer information, salesperson, description of items, payment method & more
Get the details: 17 lines enable even the biggest orders to fit on a single page
Stay organized: Bottom copy stays bound in book for a permanent record
Custom Carbonless Numbered White Receipt Books, 4-3/4" x 2-3/4", 500 Receipts per Book
Item #: 901-QFW1202001
Self-duplicating; everything is printed on original and duplicate
Book size is 11-1/2" W x 8-1/2" L; detached receipt size is 4-3/4" W x 2-3/4" L
White self-duplicating carbonless stock; pre-printed in black ink
Custom Carbonless Side-Stub Job Work Order, Large Format, 2 Parts, 1 Color Printing, 8 1/2" x 5 1/2", 500/Pack
Item #: 901-D2132
Preprinted areas for material costs, descriptions, labor, signature & dates
Last part is durable tag stock preprinted with a material & labor record for future reference
Consecutive numbering: These forms come with the option to have consecutive numbering printed on them
ComplyRight™ Employee Records Folder, Letter Size, Pack of 25 (A5001)
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
Bankers Box Liberty Corrugated File Storage Boxes, String & Button Closure, Check & Form Size, White/Blue, 12/Carton (00018)
Item #: 901-FF18
String & button, basic-duty box perfect for storing checks and forms
White/Blue corrugated storage box with standard assembly is sturdy and lightweight
Form Size, holds 23.75"W x 8.75"H files
