Medical Forms

 

Our HCFA-1500 & UB-92 (HCFA-1450) forms are used for submitting Medicare, insurance & hospital related charges. Both forms have the special Red ink for OCR scanning. Both forms are available in pinfeed or laser format. Prices shown are for one (1) box.

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HCFA INSURANCE FORM-CUT SHEET

CMS-1500 Version 08/05 Laser Cut Sheet Format - 1000 per Box
Laser cut sheet format. Printed in OCR red ink on 20 lb laser paper.

No barcode.

Quantity   1 - 2     3 - 5     6+  
Price $29.99 $28.79 $27.50
79109NPI Quantity:
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HCFA INSURANCE FORM-CUT SHEET (BULK)

CMS-1500 Version 08/05 Laser Cut Sheet Format - 2500 per Box
Laser cut sheet format. Printed in OCR red ink on 20 lb laser paper.

Quantity   1 - 2     3 - 5     6+  
Price $67.50 $63.50 $59.75
79259NPI Quantity:
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HCFA INSURANCE FORM-PINFEED

CMS-1500 Version 08/05 1-Part Continuous Pinfeed Format Form - 1000 per Box
Single part continuous pinfeed format. Printed in OCR red ink on 20 lb bond paper.

Quantity   1 - 2     3 - 5     6+  
Price $29.99 $28.79 $27.50
79106NPI Quantity:
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HCFA INSURANCE FORM-PINFEED (2PART)

CMS-1500 Version 08/05 2-Part Continuous Pinfeed Format Form - 1000 per Box
2-Part White / Canary Continuous Pinfeed format. Printed in OCR red ink on 20 lb bond.

Quantity   1 - 2     3 - 5     6+  
Price $71.99 $67.75 $63.50
79120NPI Quantity:
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HCFA INSURANCE FORM-PINFEED (BULK)

CMS-1500 Version 08/05 1-Part Continuous Pinfeed Format Form - 2500 per Box
Single part continuous pinfeed format. Printed in OCR red ink on 20 lb bond paper.

Quantity   1 - 2     3 - 5     6+  
Price $67.50 $63.50 $59.75
79256NPI Quantity:
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HCFA INSURANCE SIGNATURE LABEL

PKG/375 HCFA INSURANCE SIGNATURE RELEASE LABEL Save time by having patient sign several insurance release labels on their first visit. They can be used for subsequent claims as needed. Compatible with HCFA-1500 (CMS) forms. 375 labels per package. White.

Quantity   1 - 5     6 - 10     11+  
Price $24.50 $23.50 $22.50
7891HL Quantity:
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INSURANCE CLAIM FORM ENVELOPE

CTN/500 ENVELOPE,REG SEAL,WINDOW,INS CLAIM FORM The window placement is specifically designed to have the insurance carrier’s name and address show through the window. Simply fold the claim form so name and address show through window. Regular-Seal envelope with interior security tint. Right hand window. Overall size 9-1/2” W x 4-1/8” H. 500 envelopes per carton.

Quantity   1 - 2     3 - 4     5+  
Price $31.75 $30.50 $28.95
HC10RG Quantity:
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INSURANCE CLAIM FORM ENVELOPE

CTN/500 ENVELOPE,SELF SEAL,WINDOW,INS CLAIM FORM The window placement is specifically designed to have the insurance carrier’s name and address show through the window. Simply fold the claim form so name and address show through window. Self-Seal envelope with interior security tint. Right hand window. Overall size 9-1/2” W x 4-1/8” H. 500 envelopes per carton.

Quantity   1 - 2     3 - 4     5+  
Price $36.50 $34.50 $33.25
HC10SS Quantity:
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INSURANCE SUBMISSION ENVELOPE

PKG/100 ENVELOPE,INS SUBMISSION Jumbo insurance envelope is designed to accommodate up to 50 insurance claims to the same carrier without having to fold forms. Regular-Seal left flap. 100 envelopes per package.

Quantity   1 - 2     3 - 4     5+  
Price $19.50 $17.99 $16.50
HC912 Quantity:
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PRIVACY SIGN-IN SHEETS-BLUE

Patient Sign-In Sheet #1-23 Lt-Blue
Meet the needs of patient privacy expectations. Patients fill in information line on removable strip. Carbon sheet transfers names to back sheet so other patients do not see the previous patient's information. Overall size 8-1/2" W x 11" H. 250 forms per package.

Quantity   1 - 5     6 - 10     11+  
Price $71.55 $66.99 $62.59
18228 Quantity:
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PRIVACY SIGN-IN SHEETS-FISH

ColorForm Patient Sign-In Sheet #1-23 Lt-Blue Fish
Meet the needs of patient privacy expectations. Patients fill in information line on removable strip. Carbon sheet transfers names to back sheet so other patients do not see the previous patient's information. Overall size 8-1/2" W x 11" H. 100 forms per package.

Quantity   1 - 5     6 - 10     11+  
Price $62.25 $58.50 $54.50
17017 Quantity:
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PRIVACY SIGN-IN SHEETS-GREEN

Patient Sign-In Sheet #1-23 Lt-Green
Meet the needs of patient privacy expectations. Patients fill in information line on removable strip. Carbon sheet transfers names to back sheet so other patients do not see the previous patient's information. Overall size 8-1/2" W x 11" H. 250 forms per package.

Quantity   1 - 5     6 - 10     11+  
Price $71.55 $66.99 $62.59
18229 Quantity:
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PRIVACY SIGN-IN SHEETS-SALMON

Patient Sign-In Sheet #1-23 Salmon
Meet the needs of patient privacy expectations. Patients fill in information line on removable strip. Carbon sheet transfers names to back sheet so other patients do not see the previous patient's information. Overall size 8-1/2" W x 11" H. 250 forms per package.

Quantity   1 - 5     6 - 10     11+  
Price $71.55 $66.99 $62.59
14037 Quantity:
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PRIVACY SIGN-IN SHEETS-SMILE

ColorForm Patient Sign-In Sheet #1-23 Smile
Meet the needs of patient privacy expectations. Patients fill in information line on removable strip. Carbon sheet transfers names to back sheet so other patients do not see the previous patient's information. Overall size 8-1/2" W x 11" H. 100 forms per package.

Quantity   1 - 5     6 - 10     11+  
Price $62.25 $58.50 $54.50
17008 Quantity:
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PRIVACY SIGN-IN SHEETS-TOOTHBRUSH

ColorForm Patient Sign-In Sheet #1-23 Toothbrushes
Meet the needs for patient privacy expectations. Patients fill in information line on removable strip. Carbon sheet transfers names to back sheet so other patients do not see the previous patient's information. Overall size 8-1/2" W x 11" H. 100 forms per package.

Quantity   1 - 5     6 - 10     11+  
Price $62.25 $58.50 $54.50
17014 Quantity:

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Medical Forms

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