Description
Confidentially sign in your patients. Forms limit access to personal information as required by HIPAA. Patient signs in and waits to be called by name or number. Office staff removes numbered label strip with patient name and adheres it to patient chart to help improve record keeping. Once label strips have been removed, the patient information is now protected behind special backing paper. The sign-in form also provides confidential daily patient log. Forms numbered 1 – 23.
Product Details**
| Global Product Type | Medical Admission Forms |
| Form Type Details | Medical Admission |
| Dated/Undated | Undated |
| Forms Per Page | 1 |
| Format Indicator | Unbound |
| Copy Types | Two-Part Carbon |
| Color Family | Blue |
| Form Size | 8.5 x 11.63 |
| Sheet Size | 8.5 x 11.63 |
| Form Quantity (Total) | 125 |
| Principal Heading(s) | Date,Please Print Name,Arrival Time,Appt. Time,Appointment With,New Patient,Any Changes Since Last Visit |
| Number of Columns | 6 |
| Number of Entry Lines | 23 |
| Paper Color(s) | Blue |
| Print and Ruling Color(s) | Black |
| Numbering Color(s) | Black |
| Pre-Consumer Recycled Content Percent | 0% |
| Post-Consumer Recycled Content Percent | 0% |
| Total Recycled Content Percent | 0% |
| Special Features | Blue Sheets |
| Country Of Origin | US |
| Carton Weight | 33 lbs. |
| Carton Pack Quantity | 6 PK |
| Pack Quantity | 125 EA |
| UPC | 084371145317 |
| UNSPSC | 14111806 |
Shipping Weight & Item Dimensions
| Weight | 4.95 lbs. |
| Length | 11.625 in |
| Height | 1.75 in |
| Width | 8.5 in |
Warranty
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