1994 ADA-Approved Claim Forms - Patterson Office Supplies

1994 personalized forms allow for office/doctor’s information to be added in boxes 21-26. If in doubt about the correct ID number to use, please consult your carrier for information. You must provide us with the correct information.
ADA Dental Claim Form is reproduced and distributed by Patterson Office Supplies under license from the American Dental Association.
Title/Description
Patterson Item #
Mfg Item #
Price
Qty
1994 ADA-Approved Claim Forms, 2-Part Carbonless Sets, Personalized, 8-1/2" W x 11" H, 500/pkg
1994 ADA-Approved Claim Forms, Laser Compatible Sheet, Nonpersonalized, 8-1/2" W x 11" H, 500/pkg
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Promotion
Auto Free Good
Advantage Promotion
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.