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Physicians Telephone Order Audit 4-Part Form

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1 – 4$122.00
5 – 9$106.50
10 – 14$91.00
15 +$75.40
SKU: 982/4P

Briggs Form 982 includes a check-off audit block.

The last part on this form serves as a temporary copy as well as the mount sheet once the signed original is returned. Routing is as follows:


·      ORIGINAL COPY-Physician Please Sign and Return

·       PHARMACY COPY-Send to Pharmacy


·       CHART CONTROL COPY-Attach Original Signed Copy When Received

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


8 1/2" x 11" canary mount sheet with 4 parts, which features pressure sensitive tape for mounting on part 4. 3 detachable slips per copy measuring 8 1/2" x 3 1/4", printed in black with red ink on carbonless paper. 5 holes punched top and side. Boxed in 125s.

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