15DC2770_Clinical Forms_173-196 2/13/15 10:32 AM Page 179 Exam & Record Forms PROGRESS AND SUPPLEMENTAL NOTES MEDICAL ALERT SINGLE-SHEET FORMS Progress, Buff Paper With 2-hole Punch (367-4645) ................................................................250 per Pkg. 2 Pkg.@ 4 Pkg.@ 33.79 32.79 30.79 * Ruled front and back for documenting exam and treatment notes * 2-sided * 81/2"W x 11"H (367-7527) ..................................................................50 per Pkg. 2 Pkg.@ 4 Pkg.@ 13.99 12.99 9.99 CLINICAL FORMS * Maintain accurate records of case details and treatment * 2-sided format allows easy reading of form while attached to chart * 2-hole punch (except 368-1177) * 81/2"W x 11"H DENTAL SERVICES RENDERED FORM Progress, White Paper With 2-hole Punch (367-4665) ................................................................250 per Pkg. 2 Pkg.@ 4 Pkg.@ 34.79 32.79 30.49 Supplemental, Green Ink With 2-hole Punch (367-7523) ................................................................250 per Pkg. 2 Pkg.@ 5 Pkg.@ 32.99 31.99 29.99 Supplemental, Black Ink (368-1177) .................................................................250 per Pkg. 2 Pkg.@ 4 Pkg.@ Imprinted Materials: 800.414.0940 * 2-sided forms printed on a sturdy, 7 pt. return postcard * 81/2"W x 11"H (341-5476) ................................................................100 per Pkg. 2 Pkg.@ 5 Pkg.@ 16.99 15.99 13.99 DENTAL EXAM RECORD FORM * Printed with green ink on 80 Lb. offset opaque stock or 110 Lb. index card stock * Made from 20% postconsumer recycled content * 81/2"W x 11"H horizontal 80 Lb. Offset Opaque Stock (367-1165).................................................................100 per Pkg. 2 Pkg.@ 5 Pkg.@ 100 Lb. Index Card Stock (367-1166).................................................................100 per Pkg. 2 Pkg.@ 5 Pkg.@ 16.79 15.79 13.79 20.79 19.79 17.79 SANFORD CHECKPOINT® RED & BLUE PENCIL 33.99 32.99 30.99 8am-4:30pm (ET) * One half of the pencil is red and the other half is blue * Great for identifying and labeling patient charts (528-0000) ...................................................................12 per Box 5.99 Call To Order: 800.372.4346 8am-9pm (ET) 179http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677527%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3674645%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3415476%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3674665%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677523%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3671165%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3671166%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3681177%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D5280000%26CatalogName%3DDENTAL