Sale!
Original price was: $53.99.$43.19Current price is: $43.19.
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Type of form: Registration and history form
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250 per pack
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Size: 8 1/2″ x 11″
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Paper weight: 24 lbs.
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Binding type: Loose
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Number of parts: 1
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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
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Also features areas for severity, onset, effect on daily activities, and co, accident information alerts to different reimbursement source
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Check box for minors and space for school information, flexible patient ID number accommodates social security number, your patient ID system, or health insurance claim number
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Occupation, employer name, address and phone, emergency and pharmacy contacts
| Brand | Medical Arts Press |
|---|---|
| Customizable | No |
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