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Physicians Telephone Orders Mount Form

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$101.60
QuantityPrice
1 – 4$101.60
5 – 9$88.80
10 – 14$76.10
15 +$62.90
SKU: 989
$101.60

Features three individual snap-out-style telephone orders per 8 1/2" x 11" page with an 8 1/2" x 11" mount sheet attached. 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

When the physician has signed and returned the order, this original copy is mounted on the chart control 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 and improve efficiency!

 


•  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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