Page 14 of replacement superbill forms
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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
$70.99
Per 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
Custom Road Service Register Form, Large Format, 3 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D6133
Works with your portable register to capture details on the spot - no hunting for a handy place to write
Preprinted areas for mileage, service time, special equipment, labor & storage costs, plus much more
Signature line for customer authorization prevents disputes
Custom Register Form, Classic Design, Lg Format, Your Custom Wording, 2 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D610SW2C
Multiple layout options: Available in your choice of 3 layouts of special wording - Layout A: All Sales Final, Layout B: No Cash Returns, Layout C: Custom Message
Compatible with our registers
Consecutive numbering: These forms come with the option to have consecutive numbering printed on them
Custom Multi-Purpose Register Form, Spectra Design, Small Format, 2 Parts, 1 Color Printing, 4" x 6", 500/Pack
Item #: 901-DSP1252
Compatible with our register holders
These forms come with the option to have consecutive numbering printed on them
Additional customization options include imprinting your custom logo
Custom Register Form, Classic Design, Lg Format, Your Custom Wording, 3 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D610SW3C
Multiple layout options: Available in your choice of 3 layouts of special wording - Layout A: All Sales Final, Layout B: No Cash Returns, Layout C: Custom Message
Compatible with our registers
Consecutive numbering: These forms come with the option to have consecutive numbering printed on them
Custom Register Form, Classic Design, Large Format, NO CASH RETURNS, 2 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D610SW2B
Multiple layout options: Available in your choice of 3 layouts of special wording - Layout A: All Sales Final, Layout B: No Cash Returns, Layout C: Custom Message
Compatible with our registers
Consecutive numbering: These forms come with the option to have consecutive numbering printed on them
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 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 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 Multi-Purpose Register Form, Classic Design, Small Format, 4 Parts, 1 Color Printing, 4" x 6", 500/Pack
Item #: 901-D6094
Use with your portable register to capture details on the spot - no hunting for a handy place to write
Compatible with 4 x 6" portable registers
7 lines enable most orders to fit on a single form
Custom Register Form, Classic Design, Large Format, ALL SALES FINAL, 3 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D610SW3A
Multiple layout options: Available in your choice of 3 layouts of special wording - Layout A: All Sales Final, Layout B: No Cash Returns, Layout C: Custom Message
Compatible with our registers
Consecutive numbering: These forms come with the option to have consecutive numbering printed on them
Custom Register Form, Classic Design, Large Format, NO CASH RETURNS, 3 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D610SW3B
Multiple layout options: Available in your choice of 3 layouts of special wording - Layout A: All Sales Final, Layout B: No Cash Returns, Layout C: Custom Message
Compatible with our registers
Consecutive numbering: These forms come with the option to have consecutive numbering printed on them
Custom Multi-Purpose Register Form, Classic Design, Small Format, NO CASH RETURNS, 2 Parts, 1 Color Printing, 4" x 6", 500/Pack
Item #: 901-D609SW2B
Multiple layout options: Available in your choice of 3 layouts of special wording - Layout A: All Sales Final, Layout B: No Cash Returns, Layout C: Custom Message
Compatible with our registers
Consecutive numbering: These forms come with the option to have consecutive numbering printed on them
Custom Multi-Purpose Register Form, Spectra Design, Large Format, 2 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-DSP1262
Compatible with our register holders
These forms come with the option to have consecutive numbering printed on them
Additional customization options include imprinting your custom logo
Custom Register Form, Classic Design, Large Format, ALL SALES FINAL, 2 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D610SW2A
Multiple layout options: Available in your choice of 3 layouts of special wording - Layout A: All Sales Final, Layout B: No Cash Returns, Layout C: Custom Message
Compatible with our registers
Consecutive numbering: These forms come with the option to have consecutive numbering printed on them
Custom Multi-Purpose Register Form, Spectra Design, Large Format, 3 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-DSP1263
Compatible with our register holders
These forms come with the option to have consecutive numbering printed on them
Additional customization options include imprinting your custom logo
Custom Multi-Purpose Register Form, Spectra Design, Small Format, 3 Parts, 1 Color Printing, 4" x 6", 500/Pack
Item #: 901-DSP1253
Compatible with our register holders
These forms come with the option to have consecutive numbering printed on them
Additional customization options include imprinting your custom logo
Custom Multi-Purpose Register Form, Classic Design, Small Format, NO CASH RETURNS, 3 Parts, 1 Color Printing, 4" x 6", 500/Pack
Item #: 901-D609SW3B
Multiple layout options: Available in your choice of 3 layouts of special wording - Layout A: All Sales Final, Layout B: No Cash Returns, Layout C: Custom Message
Compatible with our registers
Consecutive numbering: These forms come with the option to have consecutive numbering printed on them
Custom Chiropractic Informed Consent Forms, 8-1/2" x 11", 250 Sheets per Pack
Item #: 901-QFN105101R
Use to provide costs and services to patients
8-1/2" W x 11" L
White 20# text stock; printed in black ink
Custom Multi-Purpose Register Form, Colors Design, Small Format, 3 Parts, 1 Color Printing, 4" x 6", 500/Pack
Item #: 901-D609T3
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 4 x 6" portable registers, sold separately
Custom 2-Part Charge Slip Forms, 8-1/2" x 11", 1000 Sets per Pack
Item #: 901-QFW1054401
For internal use in veterinary offices
8-1/2" W x 11" L
2-part, white/canary, carbonless; pre-printed in black and blue ink
Custom Multi-Purpose Register Form, Colors Design, Large Format, 4 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D610T4
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 Pest Control Form, Small Service Order Book, 3 Parts, 1 Color Printing, 3 3/8" x 6 1/4" 500/Pack
Item #: 901-D3653
Take complete orders: Preprinted areas simplify write-ups of target pests, chemicals applied, application method and more
Track customer acceptance: Signature line for customer authorization prevents disputes. Includes 3-year, at-a-glance calendar printed inside the book
Stay organized: Bottom copy stays bound in book for a permanent record
