Medical Arts Press® Insurance Assignment Release Pad
$4.99
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Description
Form specifies patient insurance coverage and authorizes assignment of payment to your practice. States patient accepts responsibility for charges. Authorizes use of signature on insurance submissions and release of health care information to designated insurance carriers. Personalization includes your name, address and phone number.
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Pad size: 4×5-1/2″
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5 pads per pack.
| # Up Per Sheet/Page : 1 | Binding Type : Padded | Brand : Medical Arts Press | Carbonless : No |
| Customizable : No | Form Size : 4″ x 5-1/2″ | Form Type : Insurance | Format : Medical Authorization Form |
| Holes Punched : None | Media Quantity : 500 | NCR Paper : No | Number of Parts : 1 |
| Numbered : No | Personalization : No | Security Features : No | Sheet Size : 4″ x 5-1/2″ |
| Weight : 0.32 lbs. per Pad |
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