Sale!
Original price was: $106.99.$72.75Current price is: $72.75.
- Buy with Peace of Mind
- Safe Transactions, Happy Customers
- Shop with Confidence, Pay Safely
- High quality products, low prices.
This form helps patients make informed choices of whether to receive items or services they may have to pay for themselves.
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Use to provide costs and services to patients
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8-1/2″ W x 11″ L
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2-part, white/canary, carbonless; printed in black ink
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250 sets per pack
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Notifies patient of services Medicare may not cover and why
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In most cases, eliminates the need for the Notice of Exclusion from Medicare Benefits (NEMB) for voluntary notifications
| # Up Per Sheet/Page | 1 |
|---|---|
| Lines | 7 |
| Security Features | No |
| Personalization | Yes |
| Package Quantity | 250 |
| Numbered | No |
| Number of Parts | 1 |
| NCR Paper | Yes |
| Media Quantity | 250 |
| Holes Punched | No |
| Binding Type | Glued/Gummed |
| Format | Medical Chart |
| Form Type | Insurance |
| Form Size | 8 1/2" x 11" |
| Customizable | Yes |
| Color | White |
| Carbonless | Yes |
| Brand | Quill |
| Sheet Size | 8 1/2" x 11" |
Be the first to review “Best deal 👏 Quill Brand Custom General Medical Custom Carbonless 2-Part Advance Beneficiary Forms, 8-1/2″ X 11″, 250 Sets Per Pack ❤️”
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