Page 8 of replacement superbill forms
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Medical Arts Press® Chiropractic Registration and History Form, 250 Forms/Pack (21701)
Item #: 901-21701
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
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
Cosco Patient Confidential Sign-In Forms, 3-Part, 125 Forms/Pack (074043)
Item #: 901-24617597
Patient Sign-In Label forms to sign in your patients confidentially
HIPAA Compliant
125 Sheets Per Package
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
Cosco Patient Confidential Sign-In Forms, 3-Part, 125 Forms/Pack (074039)
Item #: 901-24617595
Patient Sign-In Label forms to sign in your patients confidentially
HIPAA Compliant
125 Sheets Per Package
Cosco Patient Bilingual Confidential Sign-In Forms, 3-Part, 125 Forms/Pack (074042)
Item #: 901-24617599
Patient Bilingual Sign-In Label forms to sign in your patients confidentially
HIPAA Compliant
125 Sheets Per Package
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
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
TOPS™ Carbonless Job Work Order Book, 3-Part, 33 Sheets/Book (T5868)
Item #: 901-293639
Carbonless Job Work Order book is perfect to note down detail costs in both materials and labor
Dimensions: 0.3"H x 8.44"W x 5.56"L, 5.56" x 7.94" (detached form), 5.56" x 8.44" (sheet)
Color: White (primary page), white (triplicate page), canary (duplicate page), blue (ink)
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
ComplyRight 2026 Time Off Request and Approval Form, 2-Part, 50 Forms/Pack (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
TOPS 2-Part Carbonless Work Orders, 4.25"L x 7"W, 50 Sets/Book (46373)
Item #: 901-508541Q
This avoid verbal orders book provides a permanent record of instructions and warnings
Size: 4.25"L x 7"W
Features a carbonless 2-part format that allows you to keep a permanent copy for your records
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
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
Medical Arts Press Replacement Day Sheet Forms; Bond, Format S1 (WJM11)
Item #: 901-20527
Replacement day sheet forms
Number of parts: One
50/Pack
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® 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"
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
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
Tabbies 3-Part Patient Sign-in Label Forms, 125/Pack (14532)
Item #: 901-2678548
Patient sign-in label forms to sign in your patients confidentially
Form consists of three parts: a label sheet, a carbon sheet, and a log behind it
125 sheets per package
Staples Laser Forms Double Window Envelopes, Wove White, 500/Box (ST473949-CC)
Item #: 901-473949STP
Business envelopes are suitable for many mailing projects
Made from white 24 lb. paper for durability
These envelopes measure 4 1/5"H x 9"L in size, providing enough space for your mail
TOPS™ Carbonless Statement Book, 2-Part, 50 Forms/Book, 3 Pads/Pack (DC5812-3)
Item #: 901-448957
Carbonless Statement book is a great, low-cost way to keep your customer accounts current
Dimensions: 1.2"H x 5.56"W x 8.44"L, 7.94" x 5.56" (detached form), 8.44" x 5.56" (sheet)
Color: White (primary page), canary (duplicate page), blue (ink)
Adams 3-Part Carbonless Receipts Book, 7.19" x 2.75", 50 Forms/Book (ABF TC2701)
Item #: 901-TC2701
Money and rent receipt book is consecutively numbered for easy organization
Form size: 7.19"W x 2.75"L
3-Part Carbonless forms for accurate record keeping
Adams 3-Part Carbonless Receipts Hardbound Book, 2.75"L x 7"W, 200 Forms/Hardbound Book (TCH1185)
Item #: 901-TCH1185
Money receipt book is consecutively numbered for easy organization
Business form size: 2.75"L x 7"W
3-Part Carbonless forms for accurate record keeping
