Form 104-1 Ledger and Treatment Record
Has more space for services rendered, for those who prefer one column for posting fees
- Back is same as front except without patient address, etc.
- Has space for caregiver’s name and initials
- Size 8½" x 11"
- Printed 2 sides
- Grey ink on white or yellow index stock
- 100 Per Package*
- 104-1W is on white stock
- 104-1Y is on yellow stock
*If no color is specified, Yellow will be sent.
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Form 104-1 Ledger and Treatment Record
This product was added to our catalog on Monday 17 January, 2005.
