ADA 2006 Dental Claim Forms; Self Duplicating One Part Pad

Accommodates reporting of the National Provider Identifier (NPI) number Printed on recycled paper Comply with the latest HIPAA guidelines Include authorization and assignment information in lower third of form Provisions for ancillary/treatment information and the name of the treating/billing dentist Easy-to-read category headings for primary payer information, other coverage, and record of services

Recycled

Product Information

Form Type :

Insurance

Format :

Dental Claim Form

Sheet Size :

8-1/2" x 11"

Form Size :

8-1/2" x 11"

Media Quantity :

500

Binding Type :

Loose

Paper Color :

WhiteYellow

Number of Parts :

1

Carbonless :

Yes

# Up Per Sheet/Page :

1

NCR Paper :

Yes

Numbered :

No

Holes Punched :

None

Personalization :

No

Security Features :

No

Environmental Information

Certifications & Standards :

SFI Sustainable Forestry Iniative

Miscellaneous

Brand Name :

TFP

Country of Origin :

USA

Recycled :

Yes

Weight

Weight :

1.20 lbs. per Pad