Page 7 of replacement superbill forms
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ComplyRight 2024 ADA Dental Claim Forms, 1,000 Forms/Pack (202411)
Item #: 901-24602227
Forms conform to the Health Insurance Portability and Accountability Act (HIPAA)
Forms provide a common format for reporting dental services to a patient's dental benefit plan
ADA policy promotes use and acceptance latest version ADA Dental Claim Forms by dentists and payers
$65.79
Per each
Medical Arts Press FormFamily Dental History Update Form (20610)
Item #: 901-20610
Type of form: Dental history update form
250 per pack
Size: 8 1/2" x 11"
$43.59
Per pack
($0.17/EACH)
ComplyRight UB-04 Hospital Claim Form, 500 Forms/Pack (UB04LC5)
Item #: 901-24614845
Designed for hospitals to file a medical claim with the patient's insurance carrier
One-part health insurance forms
Printed with OCR dropout red ink on white paper
$40.39
Per 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
$65.79
1 pack
($0.26/EACH)
Save 5%
$61.99
2+ pack
($0.25/EACH)
ComplyRight 2024 ADA Dental Claim Forms, 500 Forms/Pack (20241500)
Item #: 901-24602228
Forms conform to the Health Insurance Portability and Accountability Act (HIPAA)
Forms provide a common format for reporting dental services to a patient's dental benefit plan
ADA policy promotes use and acceptance latest version ADA Dental Claim Forms by dentists and payers
$44.59
1-2 each
Save 8%
$40.99
3+ each
Medical Arts Press® Medications Form, Purple FormFamily™
Item #: 901-20645
Comprehensive form helps you monitor medication dosages, quantity, frequency, and refills
Printed in blue ink on white 24-lb. bond paper
Predrilled holes on top or side of form
$23.99
1 pack
($0.10/EACH)
Save 12%
$20.99
2+ pack
($0.08/EACH)
Medical Arts Press® Physical Exam Forms, Green FormFamily™, Top Punched, 250/PK
Item #: 901-20379
Type of form: Physical exam form
250 per pack
Size: 8 1/2" x 11"
$54.19
1 pack
($0.22/EACH)
Save 13%
$46.99
2+ pack
($0.19/EACH)
ComplyRight CMS-1500 Health Insurance Claims, 2500/Pack (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
$120.09
Per pack
($0.05/EACH)
TOPS Job 3-Part Carbonless Work Orders, 8.62"L x 5.67"W, 50 Sets/Book (3868)
Item #: 901-3868
Job work-order forms designed to provide a space for work, costs, and totals
Business-form size: 8.62"L x 5.67"W
3-Part Carbonless forms for accurate record keeping
$36.09
1-4 pack
($0.72/EACH)
Save 5%
$33.99
5+ pack
($0.68/EACH)
ComplyRight 2024 ADA Dental Claim Forms, 100 Forms/Pack (20241100)
Item #: 901-24602229
Forms conform to the Health Insurance Portability and Accountability Act (HIPAA)
Forms provide a common format for reporting dental services to a patient's dental benefit plan
ADA policy promotes use and acceptance latest version ADA Dental Claim Forms by dentists and payers
$14.89
Per each
Adams CMS-1500 1 Part Health Insurance Claims, 100/Pack (ABF CMS1500L1V)
Item #: 901-486075
Satisfy record keeping requirements with these health insurance claim forms
Number of parts: 1
Contains 100 forms per package
$21.99
Per pack
Medical Arts Press FormFamily Periodontal Exam Form (20607)
Item #: 901-20607
Type of form: Periodontal exam form
250 per pack
Size: 8 1/2" x 11"
$56.29
1 pack
($0.23/EACH)
Save 5%
$52.99
2+ pack
($0.21/EACH)
ComplyRight 2024 ADA Dental Claim Forms, 2,500 Forms/Pack (20241)
Item #: 901-24602226
Forms conform to the Health Insurance Portability and Accountability Act (HIPAA)
Forms provide a common format for reporting dental services to a patient's dental benefit plan
ADA policy promotes use and acceptance latest version ADA Dental Claim Forms by dentists and payers
$122.09
Per each
Medical Arts Press® FormFamily Dental Exam Form
Item #: 901-20609
Form size: 8-1/2x11"
2-hole punched on top
5-hole punched on the left side
$50.99
Per pack
($0.20/EACH)
Medical Arts Press® Progress Notes Patient Care Form; Green FormFamily™
Item #: 901-20381
Records detailed chronological notes of ongoing patient care for illnesses, treatments and progress
Helps you conform to NCQA & JCAHO guidelines
2-hole punched at top, 5-hole punched on left side
$47.69
1 pack
($0.19/EACH)
Save 7%
$43.99
2+ pack
($0.18/EACH)
Adams 3-Part Carbonless Bill of Lading, 8.5"L x 7.44"W, 250 Sets/Book (B3876)
Item #: 901-196253
Bill of lading form to ensure all your shipments arrive with the appropriate paperwork
Business form size: 8.5"L x 7.44"W; detached form size: 8.5"L x 6.94"W
3-Part Carbonless forms for accurate record keeping
$42.39
1-3 pack
Save 5%
$39.99
4+ pack
Medical Arts Press Dental Consent Form; Rainbow FormFamily (10039)
Item #: 901-10039
100 sheets per package
Size: 8-1/2" x 11"
Form Printed on 1 Side
$27.59
Per pack
($0.28/EACH)
Custom Florist Register Form, Classic Design, Large Format, TAX. DEL., 2 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D6722B
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
Medical Arts Press Replacement Day Sheet Forms; Bond, Format S1 (WJM11)
Item #: 901-20527
Replacement day sheet forms
Number of parts: One
50/Pack
$45.69
2+ pack
($0.91/EACH)
Custom Florist Register Form, Classic Design, Large Format, TAX. DEL., 3 Parts, 1 Color Printing, 5 1/2" x 8 1/2", 500/Pack
Item #: 901-D6723B
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
Medical Arts Press Pet Treatment Records, Canine, No Punch, 250/Pack (20562NP)
Item #: 901-20562NP
Type of form: Treatment record
250 per pack
Size: 8 1/2" x 11"
$59.49
Per pack
($0.24/EACH)
ComplyRight 2026 Time Off Request and Approval Form, 2-Part, 50 Forms/Pack (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
$97.69
1-4 each
Save 17%
$80.99
5+ each
Adams Security Tinted Double Window 1099 Tax Form Envelope, White, 100/Pack (S1099-3E)
Item #: 901-24496516
Simple, high-quality double-window envelope for 1099 tax forms (three-up)
Dimensions: 3 3/4" x 8 3/4"
Made of white paper
$30.79
Per pack
($0.31/EACH)
Adams Gummed Double Window 1095 B&C Tax Form Envelopes, 5-5/8" x 9", White, 100/Pack (DW1095BC18-S)
Item #: 901-DW1095BC18
Double Window Security Envelopes - 5-5/8" x 9"
For 1095B and 1095C ACA Tax Forms
Top Window - 3-7/16" x 1", Bottom Window - 3-7/16" x 3/4"
$63.99
Per pack
($0.64/EACH)
