Best deal 🤩 Quill Brand Custom CMS Forms Custom Carbonless CMS Forms, 8-1/2″ X 11″, 100 Sheets Per Pad 🎉

Sale!
Best deal 🤩 Quill Brand Custom CMS Forms Custom Carbonless CMS Forms, 8-1/2" X 11", 100 Sheets Per Pad 🎉

Original price was: $23.59.Current price is: $18.40.

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SKU: 55400855 Category: Tags: ,
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Accommodates reporting of the NPI number and is approved by the AMA’s Council on Medical Services and CMS.

  • For use by all medical facilities for billing insurance companies, Medicaid and Medicare; aligned with the electronic HIPAA ASC X12N 837 Non-institutional Transaction Standard

  • 8-1/2″ W x 11″ L

  • 1-part, white, carbonless; carbon paper is required for duplicates

  • 100 sheets per pad, order in quantities of 5 pads

  • Printed on recycled paper

  • Option to personalize tax ID#, service facility location and provider information

# Up Per Sheet/Page

1
Lines

Varies
Security Features

No
Personalization

Yes
Package Quantity

100 per Pad
Numbered

Yes
Number of Parts

1
NCR Paper

Yes
Media Quantity

100
Holes Punched

No
Binding Type

Padded
Format

Medical Complaint Form
Form Type

Medicare
Form Size

8 1/2" x 11"
Customizable

Yes
Color

White
Carbonless

Yes
Brand

Quill
Sheet Size

8 1/2" x 11"

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