Hospice 90 Day Certification/Re-Certification
$83.40
Out of stock
Product Code :
MPSBRG-3463/2P
| MPN | 3463/2P |
|---|---|
| Brand | Briggs Health Care |
| Packaging | 1 per each |
| Size | 8-1/2In x 11In |
Note : Image shown for reference purposes only. Actual product appearance may vary. Please read product description for full and accurate details.
Hospice providers can use this to obtain the 90 day certification or recertification for hospice benefits.
- Initial 90-day (Period I) authorization and Period II
- Periods III and after use Briggs form 3443/2P
| Color: | White/Canary with Black Ink |
| Size: | 8-1/2" x 11", Detached |
| Hole Punch: | 5 holes on top and left side |
| Printed: | 2 part carbonless snap set |
| Quantity: | 100 ea/pk (Also sold in a case of 20 pk/ca) |
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