ComplyRight™ HIPAA Forms, 8-1/2" W x 11" H

Patient Consent & Authorization for Release of PHI*
Patterson Office Supplies
Patterson Item #: 031-9285
Mfg Item #: AR1350

Specifications

# of Parts:
1 part
Design Color:
Black/Blue
Dimensions:
8-1/2" W x 11" H
Hole Punched:
2 hole punched at top
Manufacturer Name:
PATTERSON OFFICE SUPPLIES
Material:
70 lb Offset
Package Quantity:
200/Pkg
Printed Sides:
1 sided
Product Color:
White

Legend

Promotion
Auto Free Good
My Catalog
My Catalog (Rep)
On Formulary
On Contract
Prescription
Hazmat-Chargeable
Hazmat-No Charge
MSDS / SDS
Schedule 2 and 2N
Schedule 3, 3N, 4 and 5
List 1
No Freeze
Prices in Green indicate discounted price.