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Physicians Telephone Order 4-Part Form

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1 – 4$131.65
5 – 9$114.95
10 – 14$98.25
15 +$81.45
SKU: 989/4P

Choose the style that best meets your needs. All of the forms feature three individual snap-out-style telephone orders per 8 1/2" x 11" page with an 8 1/2" x 11" mount sheet attached. The first copy is sent to the physician for signature and the second copy is sent to the pharmacy to fill the medication order. The third copy of Briggs's four-part version can be sent directly to data entry for immediate billing. When the physician has signed and returned the order, this original copy is mounted on the chart control copy (Part 3 on the 3-part versions, Part 4 on the 4-part versions), which features pressure-sensitive tape for mounting purposes. All detachable parts are perforated between the three telephone order forms for easy individual removal.

Ask your representative today about custom imprinting this form. A quick, easy, and affordable service to personalize your form!

Each slip measures 8 1/2" x 3 1/4", printed in black and red ink on carbonless paper, white original, color-coded copies and canary mount sheets, packaged in 125s.

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