CMS 1500 (02/12) Claim Form - Patterson Office Supplies

Patterson Office Supplies carries the most up-to-date CMS claim forms. Choose from single sheet/laser compatible, 2-part carbonless duplicate sets and 1- or 2-Part Continuous . Both offered with or with personalization. Mandatory use of this form is April 1, 2014.
Personalized forms allow personalization in lines 25, 32, 32a, 32b, 33, 33a and 33b. If in doubt about the correct ID number to use, please consult your carrier for information. You must provide us with the correct information.
Title/Description
Patterson Item #
Mfg Item #
Price
Qty
CMS 1500 (02/12) Claim Forms, 1-Part Continuous, Nonpersonalized, 9-1/2 " W x 11" H, 1000/Pkg
CMS-1500 (02/12) Claim Forms, 2-Part Carbonless Sets, Nonpersonalized, 8-1/2" W x 11" H, 500/Pkg
CMS-1500 (02/12) Claim Forms, 2-Part Carbonless Sets, Personalized, 8-1/2" W x 11" H, 500/Pkg
CMS-1500 (02/12) Claim Forms, 2-Part Continuous, Nonpersonalized, 9-1/2" W x 11" H, 500/Pkg
CMS-1500 (02/12) Claim Forms, Single Sheet Bond/Laser Compatible, Nonpersonalized, Nonpadded, 8-1/2" W x 11" H, 500/Pkg
CMS-1500 (02/12) Claim Forms, Single Sheet Bond/Laser Compatible, Personalized, Nonpadded, 8-1/2" W x 11" H, 500/Pkg
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Promotion
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My Catalog
My Catalog (Rep)
On Formulary
Prescription
Hazmat-Chargeable
Hazmat-No Charge
MSDS / SDS
Additional Information
Schedule 2 and 2N
Schedule 3, 3N, 4 and 5
List 1
Prices in Green indicate discounted price.