Page 3 of hipaa patient record of disclosures
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Staples Columnar Books, 100 Pages, 6 Columns, Green, 2/Pack (217869)
Item #: 901-217869
Columnar book is ideal for accounting and record keeping
Eye-ease green-tinted paper
Includes 100 single-format pages with 6 columns
Rediform Visitors Log Book, 50 Pages, Multicolor (9G620)
Item #: 901-9G620
Place a visitor book in your lobby or reception area to welcome guests or log those who have visited your business
Wire-bound book features multicolor cover and pages with blue print on white ledger paper
Includes 50 pages with 20 lines per page that provide a space for 1000 entries
Global Printed Products Hardcover 8.5" x 11" Notary Journal, Black/Tan, 2/Pack (GPP-0094-A)
Item #: 901-24626311
2-PACK SAVINGS - Save more when you buy the Global Printed Products Notary Journal, 8.5" x 11", 2-pack. Each Journal can hold up to 380 entries.
HARDCOVER - Our Notary Journals come in a black hardcover with a matte finish and gold embossed letters, the spine of our journals is reinforced with a tan binding.
DELUXE NOTARY JOURNAL - Our notary journals feature 4 Entries per page, numbered pages, numbered entries, a durable hardcover, and black page marking ribbon.
TOPS Employee Record File Straight Cut, 20/Pack (TOP 3287)
Item #: 901-3287
Employee personal files include all you need to build a complete employee record
20 personal files per pack
Comes in white with green ink
Staples® Columnar Books, 100 Pages, Green, 2/Pack (217851ABF)
Item #: 901-217851
Columnar book is ideal for accounting and record keeping
Eye-ease green-tinted paper
Includes 100 single-format pages with 5 columns
National Canvas Tuff Series Accounting Journal, 12.13" x 7.63", Green, 250 Sheets/Book (A66500J)
Item #: 901-A66500J
Green canvas cover
Sewn binding allows book to open flat for writing
Numbered pages
Rediform 2-Part Carbonless Purchase Requisitions, 4.25"L x 7"W, 50 Sets/Book (1L114)
Item #: 901-421005
Material requisition book is consecutively numbered for easy organization
Business form size: 4.25"L x 7.88"W
Features a carbonless 2-part format that allows you to keep a permanent copy for your records
Rediform Gold Standard 2-Part Carbonless Receipts Book, 5"L x 2.75"W, 225 Forms/Book (8L829)
Item #: 901-8L829
Receipt book is consecutively numbered for easy organization
Business form size: 5"L x 2.75"W
2-Part Carbonless forms for accurate record keeping
Quill Brand® Columnar Book, 3-Columns, 80 Pages, Blue Marble (18847/26516)
Item #: 901-217737
Columnar book for record keeping
Gray marble and made of paper
Includes 80 single-format pages, comes with three columns per page, quad-ruled, 30 lines down per page
Medical Arts Press Dental Registration Forms, 250/Pack (20558)
Item #: 901-20558NP
Type of form: Dental registration form
250 per pack
Size: 8 1/2" x 11"
Medical Arts Press Registration Form; Smile Team
Item #: 901-21784
Comprehensive form gathers complete insurance information, making it easier for you to process claims
Friendly "happy teeth" design welcomes patients
Printed in 2-color on two sides on 24-lb. white bond paper
$80.29
1 pack
($0.32/EACH)
Save 7%
$74.79
2+ pack
($0.30/EACH)
Medical Arts Press® Chiropractic Registration and History Form without Updates, Sky Blue, 250 Forms/Pack (20572)
Item #: 901-20572
Forms ensure reimbursement, improve risk management and document your clinical process
Comprehensive color forms include areas for complete registration and history information, reason for visit, type of pain, site of pain or numbness
Also features areas for severity, onset, effect on daily activities, and co
$76.29
1 pack
($0.31/EACH)
Save 6%
$71.99
2+ pack
($0.29/EACH)
Medical Arts Press® Chiropractic Registration and History Form, 250 Forms/Pack (21701)
Item #: 901-21701
Forms ensure reimbursement, improve risk management and document your clinical process
Comprehensive color forms include areas for complete registration and history information, reason for visit, type of pain, site of pain or numbness
Also features areas for severity, onset, effect on daily activities, and co
Rediform Driver's Daily Log Book, 2 Part Carbon, 5 1/2" x 7 7/8", 31 Sets per Book
Item #: 901-421004
31 sets per book
2 part
Handy book format provides space to record off-duty, sleeper berth, driving and on-duty time
Wilson Jones Columnar Sheets, Ledger Paper, Ruled, 30 Lines, 20 Columns, Green Paper, 9 1/4" x 11 7/8", 100/Pk
Item #: 901-WG1020A
Double page format
20 columns
100 sheets/pack
Wilson Jones Foreman's Time Book, 4.25" x 6.8", Green, 36 Sheets/Book (S802)
Item #: 901-S802
Time book tracks each week and helps increase productivity, conveniently update your records even when you're out of the office
Stiff green pressboard cover
Includes 72 pages; tracks one week on two pages with 21 lines per page
Medical Arts Press Registration Forms without Updates Section ; Brush Silhouette
Item #: 901-21786
Comprehensive form gathers complete insurance information, making it easier for you to process claims
Silhouetted toothbrush design welcomes patients
Printed in 1-color on two sides on 24-lb. white bond paper
Boorum & Pease 21 Series Record Book, 8.13"W x 10.38"H, Black, 75 Sheets/Book (21-150-R)
Item #: 901-719682
Elegant black cover with reinforced red spine and corners
Includes 150 numbered pages
Overall dimensions: 8.13"W x 10.38"H
Rediform Visitor Book, 9.88" x 8.5", Burgundy, 64 Sheets/Book (57-803)
Item #: 901-57803Q
Keep track of visitors with this efficient visitor register book
High-quality hardcover in burgundy color
Includes 128 numbered pages of premium white paper with 14 lines per page
Medical Arts Press Dental Registration Forms Featuring Updates Section; Sky Blue, Spanish (20743)
Item #: 901-20743
Collects printed name and relationship to patient
Medication list requests correlating diagnosis
Screens for artificial heart valves, artificial joints, heart
Dome Simple Weekly Bookkeeping Record, 8.75" x 11.25", Black (600)
Item #: 901-600
Size: 8.75"x11.25"
Printed on recycled paper.
Makes bookkeeping a snap
Teacher Created Resources Chalkboard Brights 160 Pages, Lesson Planner and Record Book, Each (TCR3716)
Item #: 901-JV2127429
Lesson Planner and Record Book; Recommended for: Teachers
Includes student roster, birthday chart, grading chart and much more
Color: Multicolor
Rediform Visitor Book, 9.88" x 8.5", Black, 64 Sheets/Book (RED57802)
Item #: 901-909724
Place a visitor book in your lobby or reception area to welcome guests or log those who have visited your business
Includes pages of white recycled paper within high-quality black hardcover
Each sheet includes 14 lines per page for 1792 total entries on 128 pages
National Brand Canvas Tuff Series Record Book, 7.63" x 12.13", Green, 75 Sheets/Book (A66150R)
Item #: 901-A66150R
Book for records and daily schedules
Canvas hardcover in green
Includes 150 numbered pages with blue ruling and margin
