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Centers for Medicare and Medicaid Services Forms, 8-1/2" x 11", 250 Forms
Item #: 901-2408453
CMS-1500 claim forms (formerly known as HCFA-1500 claim forms) expedite Medicare, Medicaid or private insurance benefits
Top sensor bar for microfiche duplication, as required in some states
OCR red ink for scanning
$21.99
Per pack
ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Box of 1,000 (CMS12LC1)
Item #: 901-CMS12LC1
Includes QR code identifier at the top of the form that supports and aligns with Industry scanning systems
Printed with OCR "dropout" red ink on 20lb. paper (per government regulations)
Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
$50.99
Per carton
ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Box of 2,500 (CMS12LC)
Item #: 901-125557
Includes QR code identifier at the top of the form that supports and aligns with Industry scanning systems
Printed with OCR "dropout" red ink on 20lb. paper (per government regulations)
Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
$95.99
Per pack
ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 500 (CMS12LC500)
Item #: 901-CMS12LC500
Includes QR code identifier at the top of the form that supports and aligns with Industry scanning systems
Printed with OCR "dropout" red ink on 20lb. paper (per government regulations)
Includes new QR code identifier at the top of the form that supports and aligns with Industry scanning systems
$33.99
Per pack
ComplyRight Employee Warning Notice Forms, 50/Pack (AR0395)
Item #: 901-712137
Plus, this handy form includes space for employee and supervisor signatures.
50 Pack
Size: 81/2” x 11”
$59.99
Per pack
ComplyRight HIPAA Patient Consent and Authorization Form (A1350)
Item #: 901-398021
Attorney approved form acknowledging patient's consent to release his or her protected health information to an authorized third party
Complies with HIPAA’s authorization requirements
Size: 8 1/2" x 11"
$59.99
Per pack
ComplyRight Employee Separation Forms (AR0373)
Item #: 901-712163
50 Pack
Size: 81/2” x 11”
8 1/2" x 11"
$71.99
Per pack
ComplyRight 2023 2-Part Time Off Request and Approval Form, Pack of 50 (A0030)
Item #: 901-24202397
Calendar format makes it easy for employees to select and submit time off requests
Ensures a consistent request and approval process for all employees
Attorney-approved to ensure 100% compliance
$127.99
Per each
New Customers
ComplyRight 2024 2-Part Time Off Request and Approval Form, Pack of 50 (A0045)
Item #: 901-24202398
Calendar format makes it easy for employees to select and submit time off requests
Ensures a consistent request and approval process for all employees
Attorney-approved to ensure 100% compliance
$73.99
Per each
TOPS CMS-1500 1 Part Health Insurance Claims 500/Pack (TOP 50126RV)
Item #: 901-309934
Satisfy record keeping requirements with these health insurance claim forms
Number of parts: 1
Contains 500 forms per package
$72.99
Per pack
ComplyRight CMS-1500 Health Insurance Claim Form, 250/Box (CMS12LC250)
Item #: 901-CMS12LC250
Approved by the National Uniform Claim Committee (NUCC); HIPAA compliant
This form was revised to align the paper form with some of the changes in the electronic healthcare claims: Professional (837), 005010X222 Technical Report Type 3 (5010) and 005010X222A1 Technical Report Type 3 (5010A1)
The most significant change was the addition of 8 diagnosis codes in field 21
$28.99
Per box
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 1-Part Continuous, 1,000/Carton
Item #: 901-CMS1211
Approved by the National Uniform Claim Committee (NUCC); HIPAA compliant
This form was revised to align the paper form with some of the changes in the electronic health care claims: Professional (837), 005010X222 Technical Report Type 3 (5010) and 005010X222A1 Technical Report Type 3 (5010A1)
The most significant change was the addition of 8 diagnosis codes in field 21
$51.99
1 carton
Save 3%
$49.99
2+ carton
ComplyRight Personnel Folder, 6-Part , 25 Forms/Pack (A1175)
Item #: 901-1949186TFP
Expandable organizer offers convenient, comprehensive record-keeping
Contains six different file folders per organizer
Contains 25 organizers per package including one outer jacket and six tabbed folders each
$169.99
Per each
ComplyRight 1-Part Continuous CMS-1500 Health Insurance Claim Form (02/12), 2,500/Pack (CMS121)
Item #: 901-125542
8 1/2" x 11"
20 lb.
White
$92.99
Per box
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 1-Part Continuous with Label, 1,000/Carton
Item #: 901-CMS121B
Approved by the National Uniform Claim Committee (NUCC); HIPAA compliant
This form was revised to align the paper form with some of the changes in the electronic health care claims: Professional (837), 005010X222 Technical Report Type 3 (5010) and 005010X222A1 Technical Report Type 3 (5010A1)
The most significant change was the addition of 8 diagnosis codes in field 21
$102.99
Per carton
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12), 2-Part Continuous, White/White, 1,000/Box
Item #: 901-CMS12W2
Printed with OCR "dropout" red ink on 20# paper, as per government regulations
1,000 per case
Form is "8.5x11"
$87.99
1 box
Save 3%
$84.99
2+ box
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12), 2-Part Continuous, White/Yellow, 1,000/Box
Item #: 901-CMS122
8 1/2" x 11"
20 lb.
White
$84.99
Per box
ComplyRight™ 50-State Job Application (Long Form), Pack of 50 (A0019)
Item #: 901-1949613
Written by Employment Attorneys to ensure compliance in all 50 states
Gathers the maximum amount of information and exposes “red flags” without crossing into illegal territory
Includes tip sheet with HR best practices and compliance guidelines
$75.99
Per each
TFP UB-04 CMS-1450 1-Part Health Insurance Claims, 2500/Carton (UB04LC)
Item #: 901-519727
Designed for hospitals to file a medical claim with the patient's insurance carrier
One-part health insurance forms
Contains 2500 forms per carton
$92.99
Per carton
ComplyRight 1-Part Employee Personal Files 25/Pack (A0503)
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
$101.99
Per each
Adams Employment Applications, 50/Pad, 2 Pads/Pack (ABF 9661)
Item #: 901-9661
Includes the necessary information for every type of position
Contains 50 two-sided forms per pad, two pads per package
Perfect contrast of blue ink on white paper
$21.99
Per pack
ComplyRight 2024 Attendance Calendar Card, White, Pack of 50 (A4000W50)
Item #: 901-2548988
Calendar format on front of form makes noting absences quick and easy
Simple coding system included to aid in quickly identifying troubling patterns
Provides legal "backup" for personnel decisions, such as disciplinary action or termination
$76.99
Per pack
ComplyRight 2024 Attendance Calendar Card, White, Pack of 25 (A4000W25)
Item #: 901-2548993
Calendar format on front of form makes noting absences quick and easy
Simple coding system included to aid in quickly identifying troubling patterns
Provides legal "backup" for personnel decisions, such as disciplinary action or termination
$40.49
Per pack
Adams 1 Part Employee Personal Files, 20/Pack (9287ABF)
Item #: 901-9287
The employee personnel file folder is complete with space for any case
Number of parts: 1
Contains 20 per pack for bulk purchasing
$15.59
Per pack
ComplyRight 2024 Attendance Calendar Kit, White, Pack of 25 (A1411W16PK25)
Item #: 901-1949173TFP
Calendar format on front of Attendance Calendar Cards makes noting absences quick and easy
Simple coding system included to aid in quickly identifying troubling patterns
Back of Attendance Calendar form allows for recording absence notes, tracking leave as well as any employee warnings for attendance issues
$74.99
Per each
ComplyRight 2024 Attendance Calendar Kit, White, Pack of 50 (A1411W16PK50)
Item #: 901-1949172TFP
Calendar format on front of Attendance Calendar Cards makes noting absences quick and easy
Simple coding system included to aid in quickly identifying troubling patterns
Back of Attendance Calendar form allows for recording absence notes, tracking leave as well as any employee warnings for attendance issues
$88.99
Per each
Adams Attendance Records, 50/Pack (ABF 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
$17.59
Per pack
ComplyRight 2024 Attendance Calendar Kit, White, Pack of 100 (A1411W16PK100)
Item #: 901-1949171TFP
Calendar format on front of Attendance Calendar Cards makes noting absences quick and easy
Simple coding system included to aid in quickly identifying troubling patterns
Back of Attendance Calendar form allows for recording absence notes, tracking leave as well as any employee warnings for attendance issues
$112.49
Per each
Daily Attendance Cards
Item #: 901-370114
50 forms
1 form per page
Track employee attendance for the entire year with absence codes
$19.59
Per each
ComplyRight™ Indiana Job Application, Pack of 50 (A2179IN)
Item #: 901-1182886EDI
Written by Employment Attorneys to ensure compliance with your state laws
Gathers the maximum amount of information and exposes “red flags” without crossing into illegal territory
Includes tip sheet with HR best practices and compliance guidelines
$86.99
Per pack
TOPS Employee Record Master File, 20/Pack (TOP 3280)
Item #: 901-3280Q
Employee personal file includes all you need to build a complete employee record
20 personal files per pack
Comes in manila color with blue ink
$27.99
Per pack
ComplyRight Employee Record Organizer for Small Business, 3-Folder Set (A3103)
Item #: 901-1949185TFP
Contains 3 folders: Hiring/Employment History, Payroll/Tax and Benefits/Insurance
Back side of organizer jacket explains what records you must keep and for how long
Organizer: 9.5" x 11.875" x 1.75"
$121.99
Per each
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
$11.99
Per pack
ComplyRight 2024 Time Off Request and Approval Calendar, Pack of 50 (A0037)
Item #: 901-2548986
Calendar format makes it easy for employees to select and submit time off requests
Ensures a consistent request and approval process for all employees
Attorney-approved to ensure 100% compliance
$80.99
Per pack
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
$105.99
Per each
TOPS® Application for Employment, 2-Sided, 8-1/2 x 11", 50 Sheets/Pad, 2 Pads/Box (32851)
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
$21.99
Per box
ComplyRight™ West Virginia Job Application, Pack of 50 (A2179WV)
Item #: 901-1949687TFP
Written by Employment Attorneys to ensure compliance in all 50 states
Gathers the maximum amount of information and exposes “red flags” without crossing into illegal territory
Includes tip sheet with HR best practices and compliance guidelines
$53.99
Per each
ComplyRight 2 Part Small Request for Time Off, Pack of 50 (A2203)
Item #: 901-2549338
Attorney-approved to ensure 100% compliance
Pack of 50 forms
Clearly outlines who is requesting and who approves paid time off
$70.99
Per each
ComplyRight™ Expanded Employee Records Folder, Letter Size, Pack of 25 (A5008)
Item #: 901-1949181
Made in the U.S.A of thick, long-lasting manila card stock
Developed by Employment Attorneys for 100% Compliance
Expanded folder has 1.5” spine which holds more than 100 employee documents
$132.99
Per each
