Face To Face Encounter for Home Care
SKU
MPSBRG-3401P-15
In stock
| MPN | 3401P-15 |
|---|---|
| Packaging | 1 per each |
| Size | 8-1/2In x 11In |
$60.66
Note : Image shown for reference purposes only. Actual product appearance may vary. Please read product description for full and accurate details
- Used to capture the information needed to meet the new CMS face to face visit requirements
- Includes qualifying encounter type
- Physician Attestation including clinical findings in the physician s own words
- 2-part form allows you to keep a temporary copy while the original is out for physician completion
| Color: | Part 1: White, Part 2: Canary (Black Ink) |
| Size: | 8-1/2" x 11" |
| Hole Punch: | 5 holes on top and left side |
| Printed: | 1 side |
| Quantity: | 100 ea/pk (Also sold in a case of 20 pk/ca) |
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