Page 22 of hcfa cms 1500 health insurance business forms
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Custom Cash Receipt Book, 3-to-a-page, Triplicate, 150 Sets/Book
Item #: 901-TCRB1113
3-Up
Triplicate
150 sets per book
Custom Cash Receipt Book, 4-to-a-page, Duplicate, 300 Sets/Book
Item #: 901-TCRB1202
4-Up
Duplicate
300 sets per book
ComplyRight Patient Acknowledgment of Receipt of Privacy Practices Notice (A1354)
Item #: 901-398026
Item #: 901-398026
Attorney approved form acknowledging patient has received a Notice of Privacy Practices from his or her healthcare provider
HIPAA compliant
Size: 8 1/2" x 11"
TOPS 3-Part Carbonless Sales Orders, 5-1/2" x 7-7/8", (46510)
Item #: 901-2667638
Item #: 901-2667638
Numbered sales forms, unheaded columns
5-1/2" x 7-7/8"
Three-part carbonless (white, canary & pink)
Custom Cash Receipt Book, 3-to-a-page, Duplicate, 225 Sets/Book
Item #: 901-TCRB1182
3-Up
Dupllicate
225 sets per book
ComplyRight Employee Warning Notice, Pack of 50 (A2311)
Item #: 901-2548932
Item #: 901-2548932
Includes action to be taken, as well as explains the consequences of repeat offenses
Includes ComplyRight™ tips for optimal, compliant use
Pack of 50 forms
ComplyRight 1-Part Confidential Employee Record Folder, 25/Pack (A0503)
Item #: 901-2549341
Item #: 901-2549341
Comprehensive employee record folder helps to ensure the safety of private employee data
Number of parts: 1
Contains 25 files per package
TOPS 2-Part Carbonless Purchase Order, 8 7/16" x 5 9/16", 50 Sets/Book (46500)
Item #: 901-2667639
Item #: 901-2667639
8 7/16" x 5 9/16"
50 forms
1 form per page
Custom Cash Receipt Book, 4-to-a-page, Triplicate, 200 Sets/Book
Item #: 901-TCRB1203
4-Up
Triplicate
200 sets per book
Custom Cash Receipt Book, 3-to-a-page, Duplicate, 225 Sets/Book
Item #: 901-TCRB1112
3-Up
Duplicate
225 sets per book
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
Custom Cash Receipt Book, 4-to-a-page, Triplicate, 200 Sets/Book
Item #: 901-TCRB1143
4-Up
Triplicate
200 sets per book
Daily Attendance Cards
Item #: 901-370114
Item #: 901-370114
50 forms
1 form per page
Track employee attendance for the entire year with absence codes
Better Office 2-Part Carbonless Sales Order Book, 5.44" x 8.44", 50 Sets/Book, 3 Books/Pack (66103-3PK)
Item #: 901-24558001
Item #: 901-24558001
Sales order book is a convenient way to stay organized and track all customer transactions in your business
Size: 5.44" x 8.44"
Each carbonless two-part set features a white top sheet for recording each transaction and a bottom canary yellow sheet that captures written text from the top sheet
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
Bankers Box Liberty Corrugated File Storage Boxes, String & Button Closure, Check & Form Size, White/Blue, 12/Carton (00022)
Item #: 901-FF22
Item #: 901-FF22
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 6" x 9.5" files
Custom Carbonless Unnumbered Pocket Receipt Books, 4-3/4" x 2-3/4", 167 Receipts per Book
Item #: 901-QFW1203001
Self-duplicating; everything is printed on original and duplicate
Book Size is 10-3/4" W x 2-3/4" L; detached receipt size is 4-3/4" W x 2-3/4" L
White self-duplicating carbonless stock; pre-printed in black ink
ComplyRight Orthodontic Case Analysis File, 9.5" x 11.75", 25 Folders/Pack (A1048)
Item #: 901-24433069
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
TOPS™ Guest Check Pad, 1-Part, 100 Sheets/Pad (2100-12)
Item #: 901-196279
Item #: 901-196279
Guest Check pad is great for a home, office or business purpose
Dimensions: 3.35"H x 4.13"W x 5.44"L, 4.94" x 3.35" (detached form), 5.44" x 3.34" (sheet)
Color: White (primary page), blue (ink)
LUX W-2 / 1099 Envelopes (5 3/4 x 8) 1000/Pack, White (7489-W2-1000)
Item #: 901-23995922
Item #: 901-23995922
Comes in White
Dimensions: 5.75"L x 8"W
Moistenable Glue Sealing Method
Adams Attendance Records, 50/Pack (ABF 9493)
Item #: 901-9493
Item #: 901-9493
Control costs and keep track of employees' work schedules with daily attendance record
Contains 50 records per package
Perfect contrast of blue ink on white paper
Custom Cash Receipt Book, 4-to-a-page, Duplicate, 300 Sets/Book
Item #: 901-TCRB1142
4-Up
Duplicate
300 sets per book
TOPS® Application for Employment, 2-Sided, 8-1/2 x 11", 50 Sheets/Pad, 2 Pads/Box (32851)
Item #: 901-370031
Item #: 901-370031
2-hole punched
Application complies with all legal requirements
Includes employment history, references, education, personal information, physical record, check-offs for special questions and space for interviewer's remarks
Delforms® One-Write Payroll General Expense Check Refills; 250 with Duplicates
Item #: 901-131012
Keep track of all your payroll and general expenses in one place – in one step!
No messy carbon paper
Eliminates copy errors and saves time
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