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HIPAA-compliant insurance authorization
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Collects printed name and relationship to patient
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Medication list requests correlating diagnosis
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Screens for artificial heart valves, artificial joints, heart
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Size: 8-1/2×11″
$55.99 Original price was: $55.99.$39.19Current price is: $39.19.

| Brand | Medical Arts Press |
|---|---|
| Chart and Form Type | Standard Patient Registration Form |
| Charts Paper Weight (Lbs) | 24 |
| Color Family | Blue |
| Customizable | No |
| Height in Inches | 11" |
| Number of Pages | 250 |
| Series or Collection | Dental |
| Speciality Use | Dental |
| True Color | Blue/White |
| Used For | Registration and History Form |
| Width in Inches | 8.5" |
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