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Telephone Order Form 3-Part

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$101.60
QuantityPrice
1 – 4$101.60
5 – 9$88.80
10 – 14$76.10
15 +$62.90
SKU: 982P
$101.60

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 3 parts, which features pressure sensitive tape for mounting on part 3. 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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