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Dental Forms and Claim Forms
Dental Forms and Claim Forms
Item# TDC-17 Bi-Fold Dental Chart
Item# 50-0002 Sequential Appointment Treatment Plan
Item# 50-0011 Work Sheet
Item# 50-0020 Examination Sheet
Item# 50-0021 Work Sheets
Item# 50-0030 Telephone Checklist
Item# 50-0031 Emergency Pre-Appointment Information
Item# 50-0032 New Patient Emergency Pre-Appointment Information
Item# 50-0033 Patient Pre-Appointment
Item# 50-0034 Patient Pre-Appointment-New Patient
Item# 50-0035 Welcome/Sign In Sheet
Item# 50-0041 Emergency Questionnaire / Work Sheet
Item# 50-0043 Emergency Questionnaire / Registration
Item# 50-0044 Emergency Questionnaire / Registration 2nd Page
Item# 50-0050 Health History for Children
Item# 50-0060 Health History for Adults
Item# 50-0062 Health Questionnaire for Adults
Item# 50-0064 Medical History
Item# 50-0065 Medical History Updates
Item# 50-0066 Medical/Dental History 3-Year Update
Item# 50-0200 Professional Form
Item# 50-0220 Insurance Source File Cards
Item# 50-0230 Pending Treatment Cards-Restorative
Item# 50-0231 Pending Treatment Cards-Endo/Surgery
Item# 50-0232 Pending Treatment Cards-Crown & Bridge
Item# 50-0233 Pending Treatment Cards-Partial Denture/Misc.
Item# 50-0234 Pending Treatment Cards-Recare
Item# 50-0235 Pending Treatment Cards-Perio
Item# 50-0236 Pending Treatment Cards-Ortho
Item# 50-0250 Pending Treatment Cards-Restorative
Item# 50-0251 Pending Treatment Cards-Endo/Surgery
Item# 50-0252 Pending Treatment Cards-Crown & Bridge
Item# 50-0253 Pending Treatment Cards-Partial Denture/Misc.
Item# 50-0254 Pending Treatment Cards-Recare
Item# 50-0255 Pending Treatment Cards-Perio
Item# 50-0256 Pending Treatment Cards-Ortho
Item# 50-0258 Pending Treatment Index Set
Item# 50-0270 Inventory Cards-Restorative
Item# 50-0271 Inventory Cards
Item# 50-0272 Inventory Cards-Crown & Bridge
Item# 50-0273 Inventory Cards
Item# 50-0274 Inventory Cards
Item# 50-0275 Inventory Cards-Perio
Item# 50-0276 Inventory Cards
Item# 50-0299 Reorder Tags
Item# 50-0305 Work Sheet
Item# 50-0310 Examination Chart/Worksheet for Adults
Item# 50-0315 Work Sheet
Item# 50-0340 Examination Chart/Worksheet (Reduced Financial)
Item# 50-0350 Examination Chart/Worksheet
Item# 50-0371 Clinical Record
Item# 50-0375 Clinical Record Follow Up
Item# 50-0300 Examination Chart/Work Sheet for Adults
Item# 50-0360 Examination Chart/Case Presentation/Worksheet for Adults
Item# 50-0361 Examination Form
Item# 50-0365 Continuation of 50-0360
Item# 50-0370 Clinical Record
Item# 50-0372 Existing Exam
Item# 50-0400 Ortho Payment Plan Agreement
Item# 50-0401 Budget Plan Agreement
Item# 50-0402 Informed Consent
Item# 50-0415 Patient Treatment / Financial Agreement
Item# 50-0416 Patient Treatment/Financial Agreement
Item# 50-0490 Signature on File-Dental (Sticker)
Item# 50-0500 Adult Dental Chart Sticker
Item# 50-0510 Deciduous Dental Chart Sticker
Item# 50-0520 Periodontal Dental Chart Sticker
Item# 50-0521 Periodontal Examination
Item# 50-0522 Periodontal
Item# 50-0540 Schematic Dental Chart Sticker
Item# 50-0560 Adult Dental Chart Sticker
Item# 50-0780 Scheduling Sheets
Item# 50-0800 Change of Address Sticker
Item# 64-1590 Patient Information Chart Tri-fold
Item# 64-8700 Patient Information Chart (Tri-Fold)
Item# 70-0008 Vertical Exam Chart
Item# WADA-2002-ENV-SSI Envelope for ADA claim form – 2002
Item# WADA-2-ENV-SSI Envelope for ADA claim form – 2000
Item# WADA20061 ADA 2006 Dental Claim Form – One Part Continuous
Item# W-ADA-CCF-1-2002 Continuous Claim Form
Item# W-ADA-CCF-1-2000 Continuous Claim Form
Item# WADA20062 ADA 2006 Dental Claim Form – Two Part Continuous
Item# WADA-CCF-2-2002 Continuous Claim Form
Item# WADA2006CS ADA 2006 Dental Claim Form – Laser
Item# WADA-LCF-2000 Laser Claim Form
Item# W-ADA-LCF-CS-94 Laser Claim Form
Item# CCF-D1-90 Continuous Claim Form
Item# CCF-DN-90 Continuous Claim Form
Item# WCMENVI UB04 & ADA06 Envelopes
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Ancom Business Products an InHealth Company
Products
Custom Products
Custom Cabinets
Custom Folders
Custom Forms
Custom Indexes and Filebacks
Custom Labels
Custom Miscellaneous
Custom Stationery
File Cabinets
Custom Cabinets
Economy Laminate Open Shelf File Cabinets
Laminate Drawer Cabinets
Laminate Open Shelf File Cabinets
Rotary File Cabinets
Steel Four Post Open Shelf
Steel Stackable Open Shelf
File Folder Indexes
Alpha, Numeric, and Month Indexes
Custom Indexes and Filebacks
Exhibit Indexes
Medical Chart Indexes
Tabs and Divider Sheets
File Folder Labels
Alphabetic Color Coding Labels
Communication Labels
Custom Labels
Designation Labels
Label Printing Programs
Label Protectors and Reinforcing Strips
Legal Exhibit Labels
Miscellaneous Labels
Name Labels
Numeric Color Coding Labels
Veterinary Labels
Year Labels
File Folders
Classification and Expansion Folders
Color Folders
Custom Folders
Dividers
Fasteners
Folders with Fasteners
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Hanging File Folders
Manila Folders
Pockets
Pressboard
Starter Kits
X-Ray
Forms & Envelopes
Color Recall Postcards
Custom Forms
Dental Forms and Claim Forms
Envelopes
Eye Care Forms
HIPAA Forms and Posters
Laser Statements
Medical Billing Envelopes
Medical Forms and Healthcare Claim Forms
Mounting Sheets
Prescription Pads
Soft Sense Dental Statement
Veterinary Forms
X-Ray Mailing Envelopes
Mobile Filing Systems
"Add-a-Row" Lateral Track System
Aisle Saver Lateral Track System
Datum Bi-Slider Lateral Track System
Direct Line Bi-File Lateral Track System
High Density File Systems
Pouches & Hangers
Add-On Folder and Pouchfolder
Ancom Filing Accessories
Ancom Hanging Files
Ancom Non-Hanging Files
Specialty Products
A-Z and Out Guides
Accessories
Chart Holders/Literature
Expanding Files and Wallets
HIPAA Products
Legal Products
Promotional Products
Racks
Specialty Imprinted Products
X-Ray Products