Patient Transfer 2-Part Carbonless Form 879/2
SKU
MPSBRG-879/2
In stock
| MPN | 879/2 |
|---|---|
| Packaging | 1 per each |
| Size | 8 1/2In x 11In |
$97.94
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Developed by the Associated Hospital Service of New York, this form provides all the necessary patient information for the receiving facility when transferring a patient.
Also available:
2-part carbon interleaved
3-part carbon interleaved-extra copy Medicare intermediary (Stock No. 880/3)
Download a sample today!
Also available:
2-part carbon interleaved
3-part carbon interleaved-extra copy Medicare intermediary (Stock No. 880/3)
Download a sample today!
2 part carbonless; 8 1/2" x 11"
Detached-white original, color-coded copies; black ink
Wrapped in 100s
Detached-white original, color-coded copies; black ink
Wrapped in 100s
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