Page 11 of replacement superbill forms
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Medical Arts Press® Registration Form Featuring Updates Section/Blue Wave
Item #: 369-33018
HIPAA compliant insurance authorization
Help ensure reimbursement and improve risk management
Collects printed name and relationship to patient
$20.59
Per pack
($0.08/EACH)
Custom Carbonless CMS Forms, 8-1/2" x 11", 100 Sheets per Pad
Item #: 901-QFW1471901
For use by all medical facilities for billing insurance companies, Medicaid and Medicare; aligned with the electronic HIPAA ASC X12N 837 Non-institutional Transaction Standard
8-1/2" W x 11" L
1-part, white, carbonless; carbon paper is required for duplicates
Cosco Notice of Privacy Practices with Label, English, 8-Part, 250 Forms/Pack (074044)
Item #: 369-24644899
250 sets per pack
8-part form
Removable label for patient's folder
$199.99
Per each
Custom Florist Register Form, Colors Design, Large Format, 3 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D672T3B
Get the details: Shows so much more than a cash register receipt
Keep accurate records: Choice of different layouts for tax and delivery options
Work smarter: Compatible with our registers (sold separately)
Custom Carbonless 2-Part Forms, 8-1/2" x 11", 2 Standard Inks, 250 Sets per Pack
Item #: 901-QFNL2P1S2R
Design your own forms using your own artwork
8-1/2" W x 11" L
2-part, white/canary, carbonless
ComplyRight Payroll Change Notice Forms (AR0394)
Item #: 550-712138
Ensures all employees have updated, current payroll records
Size: 8 1/2" X 11"
50 per pack
$40.49
Per pack
Custom Full Color 3-Part Carbonless Form, 8-1/2" x 11", 250 Sets per Pack
Item #: 901-QFN13NAVQ
Design your own forms using your own artwork
8-1/2" W x 11" L
3-part, white/canary/pink, carbonless
Custom Florist Register Form, Colors Design, Large Format, 2 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D672T2B
Get the details: Shows so much more than a cash register receipt
Keep accurate records: Choice of different layouts for tax and delivery options
Work smarter: Compatible with our registers (sold separately)
Custom Full Color 3-Part Carbonless Forms, 5-1/2" x 8-1/2", 250 Sets per Pack
Item #: 901-QFN31NAVQ
Design your own forms using your own artwork
5-1/2" W x 8-1/2" L
3-part, white/canary/pink, carbonless
Custom Carbonless 3-Part Forms, 4-1/2" x 5-1/2", 1000 Sets per Pack
Item #: 901-QFN132151R
Design your own forms using your own artwork
4-1/2" W x 5-1/2" L
3-part, white/canary/pink, carbonless
ComplyRight Employee Separation Forms (AR0373)
Item #: 550-712163
50 Pack
Size: 81/2” x 11”
8 1/2" x 11"
$40.49
Per pack
Custom Carbonless 2-Part Forms, 5-1/2" x 8-1/2", 2 Standard Inks, 250 Sets per Pack
Item #: 901-QFNM2P1S2R
Design your own forms using your own artwork
5-1/2" W x 8-1/2" L
2-part, white/canary, carbonless
Custom 2-Sided Dental Registration and History Forms, 8-1/2" x 11", 250 Sheets per Pack
Item #: 901-QFN105121R
For use in patient charts
8-1/2" W x 11" L
White 20# text stock; printed in black ink
Custom Multi-Purpose Register Form, Colors Design, Large Format, 3 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D610T3
Use with your portable register to capture details on the spot - no hunting for a handy place to write
Preprinted areas simplify write-ups of customer information, salesperson, description of items, payment method & more
Compatible with 5 1/2 x 8 1/2" portable registers, sold separately
Custom Carbonless 2-Part Dental Diagnosis and Estimate Forms, 8-1/2" x 11", 250 Sheets per Pack
Item #: 901-QFN102621R
For use in providing estimates and treatment plans
8-1/2" W x 11" L
2-part, white/canary, carbonless; printed in black ink
Custom Carbonless Veterinarian Surgical Consent Form, 5-1/2" x 8-1/2", 100 Sets per Pad
Item #: 901-QFW1302901
Self-duplicating; everything is printed on original and duplicate
5-1/2" W x 8-1/2" L
White self-duplicating carbonless stock; pre-printed in black ink
Custom Multi-Purpose Register Form, Classic Design, Large Format, 3 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D6103
Use with your portable register to capture details on the spot - no hunting for a handy place to write
Preprinted areas simplify write-ups of customer information, salesperson, description of items, payment method & more
Compatible with 5 1/2 x 8 1/2" portable registers, sold separately
Custom Florist Register Form, Classic Design, Large Format, 2 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D6722D
Multiple layout options: Choice of different layouts for tax and delivery options - Layout A: Del, Tax, Layout B: Tax, Del, Layout C: Blank, Layout D: Tax
Compatible with our registers
Additional customization options include imprinting your custom logo
Custom Register Forms, Classic, Cash & Charge 2 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D158142
Die cut holes fit most standard registers
Includes personalization up to 4 lines
Imprint Color: Red
Custom Full Color 2-Part Carbonless Forms, 5-1/2" x 8-1/2", 250 Sets per Pack
Item #: 901-QFN21NAVQ
Design your own forms using your own artwork
5-1/2" W x 8-1/2" L
2-part, white/canary, carbonless
$20.59
Per pack
($0.08/EACH)
Custom Jewelry Register Form, Classic Design, Small Format, 3 Parts, 1 Color Printing, 4" x 6", 500/Pack
Item #: 901-D6072
Just for jewelers: Room for special instructions, like engraving, sizing & more - on one convenient form
Layaway agreement & payment record printed on back
Compatible with our registers
Custom HIPAA Privacy Practice Acknowledgment Forms, 8-1/2" x 11", 200 Sheets per Pack
Item #: 901-QFN155811R
For use in patient charts
8-1/2" W x 11" L
White 20# text stock; printed in black ink
Custom Florist Register Form, Classic Design, Large Format, 2 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D6722C
Multiple layout options: Choice of different layouts for tax and delivery options - Layout A: Del, Tax, Layout B: Tax, Del, Layout C: Blank, Layout D: Tax
Compatible with our registers
Additional customization options include imprinting your custom logo
