Page 23 of replacement superbill forms
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Bankers Box Liberty Corrugated File Storage Boxes, String & Button Closure, Check & Form Size, White/Blue, 12/Carton (00007)
Item #: 901-FF7
String & button, basic-duty box perfect for storing checks and forms
White/Blue corrugated storage box with standard assembly is sturdy and lightweight
Check Size, holds 9.5" x 23.27" files
$276.99
Per carton
($23.08/EACH)
Custom Illness/Injury Excuse Slips, 4" x 5-1/2", 100 Sheets per Pad
Item #: 901-QFN131511R
Excuse forms for injuries and illnesses
4" W x 5-1/2" L
White 20# text stock; printed in black ink
ComplyRight™ HIPAA Protecting Patient Privacy Poster (A2126)
Item #: 901-728247
Communicates mandatory HIPAA rules to healthcare employees
Educates employees on how and when patient's medical information may be disclosed and what to do if a breach occurs
Poster size 12 x 18"
$38.99
1-4 each
Save 5%
$36.99
5+ each
Custom Bill of Lading, Carbonless, Small Format, 3 Parts, 1 Color Printing, 8 1/2" x 7", 500/Pack
Item #: 901-D50413
Special section to identify hazardous materials
Carbonless forms for clean copies
7 description lines
Medical Arts Press Invoices, 8-1/2" x 11", 500 Sets/Book, 508/Pack (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
$54.99
1-3 pack
($0.11/EACH)
Save 9%
$49.99
4+ pack
($0.10/EACH)
TOPS Credit Card Sales 3-Part Carbonless Receipts, 3.25"L x 7.88"W, 100 Sets/Book, 5/Carton (38538CT)
Item #: 901-810999CT
Triplicate Credit Card Sales Slips are made with carbonless paper to protect your customers; no carbon tissues containing credit card information to worry about
Size: 3.25"L x 7.88"W
Features a carbonless 3-part format and comes in white
$119.99
1-2 carton
Save 8%
$109.99
3+ carton
Custom Cash Receipt Books, Classic Design, 3 To Page, 2 Parts, 1 Color Printing, 6 3/4" x 8 1/2", 500/Pack
Item #: 901-D6932
Simple: An easy way to track payments
Get the details: Receipt form features preprinted areas that document payment, payment method & account balance
Stay organized: Bottom copy stays bound in book for a permanent record
Rediform Money Receipt Books, Carbonless, 2 Parts, 2 3/4" x 5", 50 Sheets (8L820)
Item #: 901-2675655
Size: 2 3/4" x 5"
50 forms per book
Binding: Bound
$16.99
Per each
Custom Referral for Treatment Slips, 4" x 5-1/2", 100 Sheets per Pad
Item #: 901-QFN132181R
Referral forms for physicians
4" W x 5-1/2" L
White 20# text stock; printed in black ink
Bankers Box Liberty Corrugated File Storage Boxes, String & Button Closure, Check & Form Size, White/Blue, 12/Carton (00005)
Item #: 901-FF5
String & button, basic-duty box perfect for storing checks and forms
White/Blue corrugated storage box with standard assembly is sturdy and lightweight
Check Size, holds 10.75" x 23.27" files
$219.99
Per carton
($18.33/EACH)
Custom Contractor Invoice - Itemized Invoice for Large Jobs, 3 Parts, 1 Color Printing, 8 1/2" X 11" ,500/Pack
Item #: 901-D2093
Consecutively numbered for easy recordkeeping
Promote your business: Personalization includes your imprint plus choice of typeface and standard logo or custom logo
Imprint Color: Black
Custom Bill of Lading - Large Carbonless, 3 Parts, 1 Color Printing, 8 1/2" X 11" ,250/Pack
Item #: 901-D62253
Meets regulations: These forms meet all D.O.T. and I.C.C. regulations
Generous description area: 17 description lines
Identify hazardous materials. Special section to identify hazardous materials
Custom Dental Referral Slips, 4" x 5-1/2", 100 Sheets per Pad
Item #: 901-QFN105751R
Referral forms for dentists
4" W x 5-1/2" L
White 20# text stock; printed in black ink
TOPS™ Gift Certificate Book, 1-Part, 25/Book (GFTBK1)
Item #: 901-448269
Gift Certificate book to personalize your gift
Dimensions: 0.13"H x 3.25"W x 11"L, 7.81" x 3.25" (detached form), 11" x 3.25" (sheet)
Color: Cream (primary page), maroon (ink)
$9.99
Per each
Custom Illness / Injury Excuse Slips, 5-1/2" x 8-1/2", 100 Sheets per Pad
Item #: 901-QFN131541R
Excuse forms for work or school
5-1/2" W x 8-1/2" L
White 20# text stock; printed in black ink
Custom Bills of Lading - Small Carbonless, 3 Parts, 1 Color Printing, 8 1/2" x 7", 250/Pack
Item #: 901-D62053
Meets regulations. These forms meet all D.O.T. and I.C.C. regulations. Please note: For Non-Hazmat shipments only
Get the details: 6 description lines
Consecutively numbered for easy recordkeeping
TOPS® Bill of Lading Unit Set, Ruled, 4-Part Carbonless, 11-7/16" x 8-1/2", 50/Pack (3847)
Item #: 901-903257
Originals are printed in Light Blue, duplicates in Blue
White carbonless paper
Hazardous material information areas are printed in Red
$79.99
1-4 box
Save 5%
$75.99
5+ box
Rediform 2-Part Carbonless Driver's Daily Logs, 9.13"L x 5.5"W, 31 Sets/Book (REDS5031NCL)
Item #: 901-REDS5031NC
Driver's daily log book is providing plenty of space to record driving time
Size: 9.13"L x 5.5"W
Features 2-part format that allows you to keep a permanent copy for your records
$13.99
1-10 each
Save 7%
$12.99
11+ each
Medical Arts Press® Duplicate Rx Books; Alter-Proof, Horizontal
Item #: 901-16024
Tamper-resistant Rx pad features 5 security features; meets October 1st 2008 Medicaid Requirements
Alter-proof blue pattern background to ensure there are no erasures or modifications of information
Void Pantograph — the word "void" will appear when photocopied
Medical Arts Press® Tamper-Resistant Secure Rx Blanks; Single Sheet
Item #: 901-15970
Verification Box - Hold marked area between thumb and forefinger, or breathe on heat-sensitive box, the color will disappear, then reappear
Coin Reactant Ink - Rub the Rx mark on left with a coin. Ink will turn from white to gray
MicroPrint - The right and left side rules of the large box on the front have the word "security" in microPrint. Can be viewed with magnifying glass
Medical Receipt Books; Blank
Item #: 901-MRB109NI
Keep a permanent record of patient payments in chronological order
3-parts; parts one & two are perforated, part three remains in book as permanent record
Includes insert to prevent write-through
ComplyRight Expandable Confidential Personnel Envelo-File® (A0720)
Item #: 901-1949187
1.5" spine gives extra room for documents
Size: 11.75" x 9.5" x 1.5"
Protects legally sensitive documents
$126.99
Per each
Medical Arts Press® Rx Blanks; Single Copy, Horizontal, 5-1/2x4"
Item #: 901-16010MAP
Blanks can be imprinted with doctor's name and feature standard refill instructions
Please specify State License and/or DEA numbers if desired
Numbering available
Solid Color Laser Statements, Style B, with Credit Card Information, Blue
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
$46.99
Per pack
($0.09/EACH)
