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To order by phone call toll free: 1-877-840-1500

CLAIM FORMS STARTING AT $19.99

We Have the NEWEST REVISION (02/12 Version) of CMS-1500 FORMS

CMS/HCFA-1500 (NEWEST REVISION)
02/12 Version

Newest Revision of CMS-1500 forms
Individual Sheets
Newest Revision of CMS-1500 forms
Continuous Sheets
Newest Revision of CMS-1500 forms
Snapout Version


UB-04 CLAIM FORMS
UB-04 claim forms
individual sheets
UB-04 claim forms
continuous forms

Claim Form Envelopes
for CMS-1500, HCFA-1500
UB04 & UB 92 claim forms

Dental X-Ray Envelopes

Patient Valuables Envelopes

Physician's Order Sheets DPO3
Physician's Order Sheets DPO4
Physician's Order Sheets DPO5

Drug Administration Records
with Pharmacy Receipts
(DNC10)
Drug Administration Records
with Pharmacy Receipts
(DNC25)

Controlled Drug Administration Records
(D150-10)
Controlled Drug Administration Records
(D150-25)
Controlled Drug Administration Records
(D250-10)
Controlled Drug Administration Records
(D250-25)

Physician's Telephone Orders (DTO4)
Physician's Telephone Messages (DTM4)
Laboratory Reports (DC5)
Laboratory Reports (DD5)
Laboratory Reports (DVT3)
Laboratory Reports (DVT5)
Laboratory Reports (DVT13)
Laboratory Reports (DH3)
Laboratory Reports (DH5)

HIPAA Information

HIPAA Compliant Confidential Patient Sign-In System
(HIP01)

HIPAA Compliant Confidential Patient Sign-In Sheets with adhesive peel-off strips
NOW COMES IN 3 COLORS and Bi-Lingual
(HIP02) Blue
(HIP02GN) Green
(HIP02BY) Burgundy

Confidential Sign-In Logs (Generic)
(HIP03)

Bi-Lingual, English/Spanish, Blue Only
(HIP04)

Confidential Sign-In Logs (Non-Medical)
(HIP05)

HIPAA Employee Training Record
(Form #101)

HIPAA Practice Training Record
(Form #102)

Protected Health Information (PHI) Access Log
(Form #103)

Protected Health Information (PHI) Disclosure Log
(Form #104)

Patient Request for Amendment of Health Information
(Form #105)

Patient Requests for Accounting of Disclosures
(Form # 106)

Patient Request to Inspect/Review PHI
(Form #107)

Patient Request for Confidential Communications
(Form #108)

Patient Request for Restrictions on Use & Disclosure of PHI
(Form #109)

PHI Tracking Log
(Form #110)

Authorization to Release Information
(Form #111)

Notice of Privacy Practices
(Form #120)

HIPAA Compliant Notice of Privacy Practices in Spanish.
(HIP120S)

ALL OUR FORMS ARE OF THE HIGHEST QUALITY, ARE PRINTED IN STRICT COMPLIANCE WITH GOVERNMENT SPECIFICATIONS AND ARE APPROVED BY CENTERS FOR MEDICARE AND MEDICAID SERVICES AND THE INSURANCE INDUSTRY.
OUR FORMS HAVE BEEN APPROVED BY THE GOVERNMENT.
The American HCFA Forms division of DFL Enterprises, Inc. is an independent supplier of US Government
approved claim forms and NOT an affiliate of CMS (www.cms.gov)

WE ACCEPT VISA, MASTERCARD and AMERICAN EXPRESS

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IF YOU HAVE ANY QUESTIONS OR TO ORDER BY PHONE
CONTACT US TOLL FREE AT:
 1-877-840-1500
FAX: 1-985-206-5040
Our Office Hours are:
 Monday - Thursday: 8am - 5pm CST
Friday: 8am - 12 noon CST

EMAIL US

AMERICAN HCFA FORMS is a Division of
177 Kensington Dr, Madisonville, LA 70447
PHONE: 985-875-0800
FAX: 1-985-206-5040

Associated sites:
CMSforms.com - HCFA1500Forms.COM

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