Page 3 of hcfa cms 1500 health insurance business forms
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Accounting & Record Journals (104) -
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Top
Solid Color Laser Statements, Style B, with Credit Card Information, Blue
Item #: 901-33176A
Item #: 901-33176A
Credit Card Alert Helps Speed Payment - Visa & Mastercard only
Includes Patient Update
Easy-Tear Perforation Is 3.68" From top for Removal Of White Payment Stub
Medical Arts Press Eye Care Registration Form (20571)
Item #: 901-20571
Item #: 901-20571
Type of form: Registration form
250 per pack
Size: 8 1/2" x 11"
Medical Arts Press Invoices, 8-1/2" x 11", 500 Sets/Book, 500/Pack (30471A)
Item #: 901-30471A
Item #: 901-30471A
Light Teal Background on Front
Back Is White with Printed Change Of Address & Visa & Mastercard Credit Card Payment Sections
Perforation Is 3-11/16 From top Of Sheet
Medical Arts Press® Continuation Notes, White, No Punch Option
Item #: 901-20131NP
Item #: 901-20131NP
Type of form: Continuation note
500 per pack
Size: 8 1/2" x 11"
Medical Arts Press® Progress Notes, No Imprint, 250/Pack (21757NP)
Item #: 901-21757NP
Item #: 901-21757NP
Type of form: Progress note
250 per pack
Size: 8 1/2" x 11"
Medical Arts Press Pet Treatment Records, Canine, No Punch, 250/Pack (20562NP)
Item #: 901-20562NP
Item #: 901-20562NP
Type of form: Treatment record
250 per pack
Size: 8 1/2" x 11"
Medical Arts Press Pet Treatment Records (20557)
Item #: 901-20557
Item #: 901-20557
Type of form: Treatment record
250 per pack
Size: 8 1/2" x 11"
Medical Arts Press Treatment Notes, Tooth #, Non-Imprinted, No Punch, 250/Pack (20560NP)
Item #: 901-20560NP
Item #: 901-20560NP
Type of form: Treatment note
250 per pack
Size: 8 1/2" x 11"
Medical Arts Press Invoices, 500 Sets/Book, 509/Pack (19906A)
Item #: 901-19906A
Item #: 901-19906A
Features Visa, Mastercard, Discover & American Express Logos
Easy-Tear Perforation Allows Top To Be Detached & Returned with Payment
Perforation Is 3.68 From top Of Statement
Medical Arts Press Invoices, 8-1/2" x 11", 500 Sets/Book, 500/Pack (30465C)
Item #: 901-30465C
Item #: 901-30465C
Solid Color Style D Purple without Credit Card Information Laser Statements
Size: 8.5 X 11 inch
500/Package
Medical Arts Press® Progress Notes, Horizontal and Vertical ID, Ivory
Item #: 901-20121NP
Item #: 901-20121NP
Type of form: Progress note
250 per pack
Size: 8 1/4" x 10 3/4"
Medical Arts Press Invoices, 8-1/2" x 11", 500 Sets/Book, 500/Pack (33176D)
Item #: 901-33176D
Item #: 901-33176D
Credit card alert helps speed payment - VISA and MasterCard only
Includes patient update
Easy-tear perforation is 3-11/16" from top for removal of white payment stub
Medical Arts Press Invoices, 8-1/2" x 11", 500 Sets/Book, 508/Pack (19906C)
Item #: 901-19906C
Item #: 901-19906C
Perforation Is 3-11/16 From top Of Statement
Back Print Includes Area For Updating Patient Information to Help Keep Files Current
Size: 8.5 x 11 inch
Medical Arts Press Standard Preprinted Chart Divider Tabs, Patient Information, Orange (30583)
Item #: 901-30583
Item #: 901-30583
Orange tab
100/box
Titles are printed in black ink on white stock with a color-coded edge
Medical Arts Press® Tamper-Resistant Laser Rx Paper; 2 RX Blanks/Sheet, High Security, 500/Pack (SECR1PLBK)
Item #: 901-83401
Item #: 901-83401
Security features exceed industry guidelines and meet all Medicaid requirements
Void pantograph - the word "VOID" appears when form is photocopied
Chemical protection - stains or spots appear with chemical alteration
Medical Arts Press Pet Treatment Records, Feline (20563RL)
Item #: 901-20563NP
Item #: 901-20563NP
Type of form: Treatment record
250 per pack
Size: 8 1/2" x 11"
Medical Arts Press® Copy-Proof Rx Blanks; Carbonless Duplicate Books
Item #: 901-16019
Item #: 901-16019
6 security features comply with CMS 10/1/08 Tamper Resistant Requirements for Medicaid
Copy-proof Rx blanks feature a blue pattern background; "void" pantograph appears when copied
Micro-print signature line helps prevent counterfeiting and states security when viewed through a magnifying glass; security band lists security features
Medical Arts Press® Continuation Notes, Blue, No Punch
Item #: 901-20134NP
Item #: 901-20134NP
Type of form: Continuation note
500 per pack
Size: 8 1/2" x 11"
Medical Arts Press® Tamper-Resistant Laser Rx Paper; 1 RX Blank/Sheet, High Security, 500/Pack
Item #: 901-83405
Item #: 901-83405
Security features exceed industry guidelines and meet all Medicaid requirements
Void pantograph - the word "VOID" appears when form is photocopied
Chemical protection - stains or spots appear with chemical alteration
Medical Arts Press® Copy-Proof Rx Blanks, Single Sheet Pads
Item #: 901-16015
Item #: 901-16015
6 security features comply with CMS 10/1/08 Tamper Resistant Requirements for Medicaid
Copy-proof Rx blanks feature a blue pattern background; "void" pantograph appears when copied
Micro-print signature line helps prevent counterfeiting and states security when viewed through a magnifying glass; security band lists security features
Medical Arts Press® Veterinary Animal Record Progress Notes, Narrow Ruled
Item #: 901-20475
Item #: 901-20475
Type of form: Veterinary progress note
250 per pack
Size: 8 1/2" x 11"
Medical Arts Press® Progress Notes; Reinforced, Top Punched, 250/Pack (20555)
Item #: 901-20555
Item #: 901-20555
Provides plenty of room to record patient progress and your findings at subsequent visits
Record patient name, birth date and gender
Ruled back side
Medical Arts Press Treatment Notes, Tooth Diagram, Non-Imprinted, No Punch
Item #: 901-21150NP
Item #: 901-21150NP
Set per pack (uom): 250 per pack
Size: 8 1/2" x 11"
Dental exam chart format
Medical Arts Press® Single Rx Blanks; Alter-Proof, Indiana, 1 Part
Item #: 901-16031P
Item #: 901-16031P
Specifically designed to meet state requirements when prescribing controlled substances in Indiana
Printed on tamper-proof safety paper
Please specify doctor's name and State License and/or DEA numbers if desired
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