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Medicaid Prescription Pads, Medicaid Rx Pads, Medicaid Tamper Resistant Prescriptions, CMS-1500 Forms, HCFA 1500 Forms, HCFAs, CMS-1500 Forms, Clinical Forms, Rx Pads, Prescription Pads, Medical Forms, Dental Forms, Medical Office Supplies, HCFA Envelopes, HIPAA Forms, Patient Charts, Medical Office Filing Supplies,
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Red/White Q Label Jeter® 2900 Compatible
ITEM # 1676Q
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REDIFORM : Employee Application
Complete information in an easy-to-understand format. Revised to comply with the Americans with Disabilities Act (ADA). Top punched, printed both sides. 50 sheets per pad with cover. Americans with Disabilities Act Requirement: . . .information obtained regarding the medical condition or history of an individual is to be collected and maintained on separate forms and in separate medical files and is to be treated as a confidential medical record. Section 102 (c) (3).
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1 1/4 x 5/16 Fl. Green 500 per Roll
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1 1/2 x 7/8 Fl. Orange 250 per Roll
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1 1/2 x 7/8 Fl. Pink 250 per Roll
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1 1/4 x 5/16 Fl. Pink 500 per Roll
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Referral#/Expires/#Visits/Diagnosis
3 1/4 x 1 3/4 White 250 per Roll
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1 1/2 x 7/8 Fl. Orange 250 per Roll
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1 1/2 x 7/8 Fl. Pink 250 per Roll
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Regular payment must be made every month
Fl. Pink 1 1/2" x 7/8" (250/Roll)
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Fl. Green 2 1/4" x 7/8" (420/Roll)
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FL. Green 3 1/4" x 1 3/4" (250/Roll)
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1 1/2 x 7/8 Fl. Green 250 per Roll
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Steel jaws; plastic grips.
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Request for Access to Protected Health Information
ITEM # 18240
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Request for Accounting of Disclosures
ITEM # 18242
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Request for Restriction of Patient Health Care Information
ITEM # 18241
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Response for Amendment or Correction of PHI
ITEM # 18251
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Response to Amend Protected Health Information
ITEM # 18246
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Response to Amend Protected Health Information
ITEM # 18246
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ITEM # 18248
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Response to Request for Access
ITEM # 18247
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Response to Request for Restriction
ITEM # 18250
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