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Patient Encounter Form
Patient Encounter / Superbill Form
 
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List Price: $165.00
Your Price: $145.00
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Setup Cost: $0.00
Unit Qty: 500
Unit: pack
Overall Dimensions: 8 1/2 x 5 1/2"


Product Code: 860-3-DFS

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Patient Encounter Form Pre-printed with your information, includes blank spaces to add your own Diagnostic Codes.

  • Snap Apart Form - Glued Top
  • Printed in Black Ink3 Parts - White, Canary & Pink
  • 8-1/2" x 5 1/2"
  • 500 per pack
  • Personalization includes- Includes your imprinted practice name, address, and phone number, up to 5 lines. 3-part form provides a patient copy and a 2-hole punched permanent record.

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