Physicians Orders 5-Part Form

For maximum flexibitlity in an economically priced 5-part Physicians Order, consider Briggs Form 1279/5.

*Separate copies for as many as four different departments.

* Three orders printed on each form.

* Block-out section to prevent writing across checklist area.

* 5-hole punched side stub for use in side-ring charts.

* Can also be used as Physicians Telephone orders

* Packaged in boxes for 200 for easy distribution and storage.

* Addressograph space for patient information.

To use this form, have a physician write his/her orders on the form - the orders will automatically be transferred to all copies. Part 1 features a block out section to prevent accidentally writing over the department checklist on Parts 2-5. Remove all copies along the perforations. Check the departments for copy distribution, or use the blank spaces to indicate departments not listed. The original stays as a permanent record in the patients file.