Patient Information Form – Easy To Read (Model # IH58-8427)
- Minimum order: 100 Patient Information Forms
- Easy-to-read, two-color design covering patient and responsible party information
- Printed both sides in black and lavender ink
- Two-hole punched at the top and bottom
- Size: 8 1/2″ w x 11″ h
$25.00
Additional information
| Weight | 1.26 lbs |
|---|
Related products
-
Quick-Stick Rx Prescription Carriers (Model # IH25-7124)
$122.50 Add to cartQuick-Stick Rx Prescription Carriers (Model # IH25-7124)
- 250 Quick-Stick Rx Prescription Carriers/Package
- 12 form capacity for users of two-part Rx forms
- Duplicate copies affixed in chronological order by shingling from bottom to top
- Zip tape for easy affixing of Rx forms
- Two-hole punched at the top and side
- Goldenrod bond stock
- Size: 8 1/2″ w x 11″ h
$122.50 -
CMS 1500 Claim Form Jumbo Envelope (Model # IHE1500)
$80.00 Add to cartCMS 1500 Claim Form Jumbo Envelope (Model # IHE1500)
- 100 CMS 1500 Claim Form Jumbo Envelopes/Package
- Full-size insurance envelope with open side with gummed flap designed for CMS 1500 Claim Form submission
- Custom window placement displays insurance carrier’s name and address
- Holds up to 50 claim forms to the same carrier
- Recommended for use with claim forms without bar codes
- Saves time, postage, and labor costs
- Size: 9″ h x 13″ w
$80.00 -
Adhesive Telephone Message and Response Slips (Model # IHF287)
$23.88 Add to cartAdhesive Telephone Message and Response Slips (Model # IHF287)
- 100 Messages slips/package
- Adhesive Patient Message Form
- Complete the message portion when a patient calls
- Affix the top portion to the outside of the patient chart if a response is required
- After follow-up, remove and attach inside the chart to progress note or telephone message carrier in shingle fashion
- For full view, remove the remaining adhesive strip and affix directly
- Size: 8″ w x 3 1/2″ h
$23.88 -
Medication List (Model # IH25-7202-01)
$42.50 Add to cartMedication List (Model # IH25-7202-01)
- 250 Medication List Forms/Order
- Flip-up style allows viewing of all current medications and refills at a glance
- Printed head to foot for flip-up filing
- Two-hole punched at the top and bottom
- Size: 8 1/2″ w x 11″ h
$42.50
