Physician's Telephone Orders  DTO4

DTO4 Physician's Telephone Orders CLICK TO ENLARGE

Usage:  Allows for 1 to 10 telephone messages to be posted for collection and viewing purposes in the patient's chart. Message forms need to be at least 5" in width to fit our stock form.  Can be used in 3 ring left binder and 2, 3 or 5 hole top chart style.

Base Specifications:

Size:  8 ½ x 11
Paper:  20# White
Ink:  PMS 347 Green
Punching:  Punch 5 holes left & 5 top
Fastening:  2 Permanent Tapes – ½" x 11"
                 1 finger lift size
                die cut into 9 sections
Packaging:  250 per Inner Box
                  500 per Carton

Discounts available for large quantities.
Contract pricing available. Call for details!

Physician's Telephone Messages DTM4

DTM4 Physician's Telephone Messages CLICK TO ENLARGE

Usage:  Allows for 3 ring binder filing or use.  Write each message as needed.  Pull out from vertical perf at left for the length of message, then pull down and separate on horizontal perf.

Fill in stub notes at left, remove transfer tape on back of message form and stick to patients chart for permanent and easy viewing.

Special Design Features:

• Die cut to fit each message form
• Each message from size is 2 3/4'" x 6"
• Highlights medication allergy to alert medical personnel

Base Specifications:
Size:  8 ½ x 11
Paper:  20# White RB
Ink:  PMS 347 Green
Punching:  Punch 3 holes left – 4-1/4 cc (1/4")
Perforations:  1 Full Vertical Perf
                    3 Partial Horizontal Perfs

Fastening:  2 Permanent Tapes – ½" x 11" On Back

Packaging:  250 per Inner Box
                  500 per Carton

Discounts available for large quantities.
Contract pricing available. Call for details!

DC-5
Laboratory Reports
CLICK TO ENLARGE

Discounts available for large quantities.
Contract pricing available. Call for details!

DVT3
Laboratory Reports
CLICK TO ENLARGE

Discounts available for large quantities.
Contract pricing available. Call for details!

DVT5
Laboratory Reports
CLICK TO ENLARGE

Discounts available for large quantities.
Contract pricing available. Call for details!

DH-3
Laboratory Reports
CLICK TO ENLARGE

Discounts available for large quantities.
Contract pricing available. Call for details!

DH5
Laboratory Reports
CLICK TO ENLARGE

Discounts available for large quantities.
Contract pricing available. Call for details!

DD5
Laboratory Reports
CLICK TO ENLARGE

Discounts available for large quantities.
Contract pricing available. Call for details!

DVT13
Laboratory Reports
CLICK TO ENLARGE

Discounts available for large quantities.
Contract pricing available. Call for details!

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)