White forms with blue-shaded notes space. Space to record Caller, Company, Phone/Fax numbers, Date, Time and Notes, with additional lines for detailed notetaking of each call. Completed check-off box for quick visual reference.
Expedite Medicare, Medicaid or private insurance benefits. NUCC, CMS and AMA approved format. (02/12) version. Printed front and back in red OCR...
White forms with blue-shaded notes space. Space to record Caller, Company, Phone/Fax numbers, Date, Time and Notes, with additional lines for detailed notetaking of each call. Completed check-off box for quick visual reference.