Physicians Telephone Orders Mount Form

Choose the style that best meets your needs.All of the forms shown on these two pages feature three individual snap-out-style telephone orders per 8 1/2" x 11" page with an 8 1/2" x 11" mount sheet attached. The first copy is sent to the physician for signature and the second copy is sent to the pharmacy to fill the medication order. The third copy of Briggs four-part version can be sent directly to data entry for immediate billing. When the physician has signed and returned the order, this original copy is mounted on the chart control copy (Part 3 on the 3-part versions, Part 4 on the 4-part versions), which features pressure-sensitive tape for mounting purposes. All detachable parts are perforated between the three telephone order forms for easy individual removal.

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