Physician Orders NCR 1206

This form is uniquely designed to allow you to leave the original in the patient s chart, removing each copy without taking the actual form out of the chart. Each time an order is written, the image is transferred only to the sheet directly under the original, which is removed and sent to the pharmacy.

There are 22 total lines per form, providing ample writing room for each successive physician order.
Up to4 orders can be written using this 5-part form.

Also available in 4-part (Stock No. 1206/4).