Pegboard promo website

Featured Product
Printco
Incorporated
Pegboard Products
Did you know along with all the innovative products
Printco offers we also have dependable one-write
systems? These systems have stood the test of time and
continue to be the perfect solution for start up
organizations or small business owners. Easy to use just write once to eliminate multiple data entries and
minimize errors.
Contact us now for
more information!
PAY TO THE ORDER OF
TIME
WKD.
•
•
•
•
•
•
Reg.
EARNINGS
O.T.
Total
F.I.C.A.
DEDUCTIONS
St. Tax
Fed. Tax
REFERENCE
DETACH STUB BEFORE DEPOSITING
AMOUNT
AMOUNT
NET PAY
AMOUNT
REFERENC E
.
S TATEMENT
Printco, Inc
Omro, WI 54963
Product Code NB-FE B
PAY PERIOD
CHECK NUMBER
FAMILY
MEMBER
DESCRIPTION
CHARGE
CREDITS
Payment s
Adj
Adj.
CURRENT
BALANCE
BALANCE FORWARD
RECEIPT
NUMBER
DATE
PROFESSIONA L SER VICE
CHARG E
P AID
�
This is your RECEIP T for this amount
This is a STATEMENT of your account to date
NEW
BALANCE
�
PREVIOU S
BALANCE
NAME
Please present this s lip to receptionist before leaving office.
SER VICES RENDERE D
Dealer
Address
Phone
SER
ABC BUSINESS
PRINTCO, INC.
Omro, WI 54963
Product Code MB-LLE
123 Your Address
City, State Zip Code
(000) 000-0000
OV-OFFICE VISIT
PH-PHYSICAL
PLEASE PAY LAST AMOUNT IN THIS COLUMN
Checks
Charge Receipts
Medicoms
Journal Sheets
Check Registers
Ledger Cards
Contact customer service at 920-685-5662 for help
selecting the one-write system that best fits your customers
needs.
RV-RETURN VISIT
XR-X-RAY
NP-NEW PATIENT
EM-EXAMINATION
EP-ESTABLISHED PATIENT
NEXT APPOINTMENT____________________________________
DATE
S-SURGERY
TR-TREATMENT
TOTAL
NEXT
APPOINTMEN T_ _______________________
AT _________________
TIM E
No 015757
No 015757
No 015757
THIS IS A COPY OF YOUR ACCOUNT AS IT APPEARS ON YOUR LEDGER CARD
DATE
FAMIL Y
MEMBER
DESCRIPTIO N
TO TA L
FEE
This is your RECEIP T for this amount
MF-23-11
P______________
DATE
Register for our educational webinar
on July 10th at 10 am or 2 pm CST.
Email [email protected]
or on-line at www.printlearn.com.
Pegboard accounting systems are the perfect solution
for saving time and money while keeping accurate
records.
PAY ___________________________________________________________________________ DOLLARS
DATE
Interested in
Flat Printed Items?
PAY MENT
CREDITS
�
ADJ.
PREVIOUS
BALANCE
BALANCE
�
PATIENTʼS NAME
This is a STATEMENT of your account to date
ATTENDING PHYSICIAN’SSTATEMENT - Current CPT Codes - HCPCS Codes
OFFICE EVALUATION/MANA
GEMENT
LABORATORY
Fee
Est.
New
_______ 81000 UA
_______ 88150 Pap Smear
_______ 99212 99201 _______ 87880 Strep Te st
_______ 87210 Vaginal S mear
_______ 99213 99202 _______ 85013 HCT
_______ 82962 Blood Sugar
_______ 99214 99203 _______ 82270 Occult B ld.
_______ 84703 Preg. T es t
_______ 99215 99204 _______ 80053 Multichem.
_______ 80061 Lipid Panel
_______ 99211 99205 _______ 85031 CBC/Diff.
_______ 84439 Free T4
_______ 99391 99381 Prev . Care (<1yr)
_______ 84153 PSA
_______ 84443 TSH
_______ 99392 99382 Prev . Care (1-4yr)
_______ 35415 G0001 _______ 87088 Urine Culture
_______ 99393 99383 Prev . Care (5-11yr)
_______ _____ ____________ _______ 87184 Sensitivit y
__________
_______ 99394 99384 Prev . Care (12-17yr)
_______ _____ _____________________________
HOSPITAL EVALUATION /MANAGEMENT
_______ 99395 99385 Prev . Care (18-39yr)
Date of Admission _______________ Discharge _______________
_______ 99396 99386 Prev . Care (40-64yr)
_______ 99221 99222 99223 Admit
PROCEDURE S
_______ 99291 Critical Care
_______ 93000 EKG
_______ 99231 Daily Care, _______ Days@________/day
_______ 17000 Lesion Removal, First Lesio n
__ _________
_______ _____ ____________________________
_______ 17003 Lesion Removal, #2-#14
_______ 99232 Daily Care, _______ Days@________/day
_______ 86585 TB Ti ne 86580 Mantoux
_______ _____ ____________________________
__ _________
_______ 69210 Cerumen Removal
_______ 99238 Discharge Management
INJECTIONS - IMMUNIZA
TIONS
_______ 99253 99254 Consultation
_______ 90701 DTP
_______90707 MMR
_______ 99431 Newborn, Initial
_______ 90700 DTaP _______90718 dT
_______ 99433 Newborn Daily Care, _______ Days@__ _____/day
_______ 90713 OPV
_______90720 Te tramune
_______ 54150 Circumcisio n
_______ 90658 Influ.
_______90732 Pneum.
__ _________
_______ _____ ____________________________
_______ 90744 90746 Hepatitis B
__ _________
_______ _____ ____________________________
_______ 90632 90633 90634 Hepatitis A
COMMENTS /OTHER SER VICES
_______ J 3420 Vit. B12 ____ml, I.M.
_________________________ ______________________________
_______ 90782 Medication ______________ _______
_______ G0008 Vaccine Admin. - Influenz a
_________________________ ______________________________
_________________________ ______________________________
_______ G0009 Vaccine Admin. - P neumoni a
_______ 90741 Vaccine Admin. - One Vaccine
RETURN: __________ DAYS __________ WKS
_______ 90742 Vaccine Admin. - Two or More
__________ MONTHS __________PRN
Patient Name ____________________
Compatible
Formats
Wide
Selection of
Pantographs
Rush
Service
___________
Date of S ervice _____________________________
DIAGNOSIS:_______________ ________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
TOTAL CHARGES
$ __________________
NOTICE TO INSURANCE CARRIERS:
The information on this form should be adequate to
process the patient ʼs claim. If more information is
requested, it will be necessary to charge an appropriate
fee.
SAVE FOR MAJOR MEDICAL INS. ANDTAXES
Options:
Four Standard Punch Styles
Matching Envelopes
A Wide Range of Compatible Systems
Printco is the right choice for your business partner!