CMS-1500 CLAIM FORMS - NEWEST REVISION
Version 02/12
 
AVAILABLE IN INDIVIDUAL SHEETS and
ONE or TWO PART CONTINUOUS (PINFEED) FORMS
ON HIGH-QUALITY PAPER TO GOVERNMENT STANDARDS.

INDIVIDUAL SHEETS

CONTINUOUS

SNAPOUT

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Description

Quantity/Case

Price/Case

Secure Order

Individual Sheets

500

$19.99


Quantity:

 

Individual Sheets

2500

$35.00


Quantity:
 

1 Part Continuous

2500

$35.00


Quantity:
 

2 Part Continuous
1st Sheet White,
2nd Sheet White

1000

$42.95


Quantity:
 

2 Part Continuous
1st Sheet White,
2nd Sheet Canary

1000

$42.95


Quantity:
 

Snapout
Version

500

$35.00


Quantity:
 

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)

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