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

New! Newest Revision of CMS-1500 forms
Individual Sheets
New! Newest Revision of CMS-1500 forms
Continuous Sheets


CMS/HCFA-1500 (08/05 VERSION)
08/05 Version of CMS-1500 forms
individual sheets
08/05 Version of CMS-1500 forms
continuous forms
08/05 Version of CMS-1500 forms
snapout forms

HCFA 1500 FORMS (12/90 VERSION)
individual sheets (with bar code)
individual sheets (without bar code)
continuous forms 1 part (with bar code)
continuous forms 1 part (without bar code)
continuous forms 2 part (with bar code)
continuous forms 2 part (without bar code)

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

UB-92/CMS-1450/HCFA-1450
individual sheets
continuous forms

HOME HEALTH CARE FORMS
CMS-485 continuous forms
CMS-486 continuous forms
CMS-487 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)

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)

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)

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: 1-985-809-5788
Our Office Hours are:
  Monday - Thursday:  8am - 5pm CST
Friday:  8am - 12 noon CST

EMAIL US

AMERICAN HCFA FORMS is a Division of

124 Pine Oak Dr., Covington, LA  70433
PHONE:  985-875-0800
FAX: 1-985-809-5788

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HIPAASignIn.com | ub92.net | discountclaimforms.com

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