W-PSGN Patient Sign In Form

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Product Code: W-PSGN

To order, call 1-800-722-4884

Description

Meet the needs of patient privacy expectations. Patients fill in information line on removable strip. Carbon sheet transfers names to back sheet so other patients do not see the previous patient's information. Light Blue.

Overall size 8-1/2" W x 11" H.

250 forms per package.

Formerly Part Number 18228

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