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Patient Transfer 2-Part Carbonless Form 879/2

In stock

SKU

MPSBRG-879/2

More Information
Brand	Sage
MPN	879/2
Packaging	1 per each
Size	8 1/2In x 11In

$124.00

Details

Developed by the Associated Hospital Service of New York, this form provides all the necessary patient information for the receiving facility when transferring a patient.

Also available:
2-part carbon interleaved
3-part carbon interleaved-extra copy Medicare intermediary (Stock No. 880/3)

Download a sample today!

2 part carbonless; 8 1/2" x 11"
Detached-white original, color-coded copies; black ink
Wrapped in 100s

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