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., Covington, LA 70433PHONE: 985-875-0800 FAX: 1-985-809-5788Home HCFA-1500 Forms CMS-1500 Forms UB04 Forms UB-92/CMS-1450/HCFA-1450 Forms CMS 485,486,487 Forms Claim Form Envelopes...HOME HEALTH CARE FORMSCMS-485... CMS 485, 486, 487 HOME HEALTH CARE CLAIM FORMS CMS 485 AND CMS 487 FORMS ARE AVAILABLE AS 4 PART CONTINUOUS (TRACTOR-FEED) FORMS AND CMS 486 FORMS... ARE AVAILABLE AS 3 PART CONTINUOUS FORMS. CMS-485CMS-486 CMS-487CLICK IMAGE TO ENLARGE DescriptionQuantity/CasePrice/CaseSecure OrderCMS 4854 Part Continuous500$55.00 Quantity...

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Dr., Covington, LA 70433PHONE: 985-875-0800FAX: 1-985-809-5788Home HCFA-1500 Forms CMS-1500 Forms UB04 Forms UB-92/CMS-1450/HCFA-1450 Forms CMS 485,486,487 Forms Claim Form...Protected Health Information... Protected Health Information (PHI)Disclosure Log (Form #104) As required by HIPAA, you must track to whom disclosures of PHI are made. This form..., retained in each patient's medical record, includes the pertinent information that should be recorded when disclosures are made. This form will be photocopied for patients who...

of 124 Pine Oak Dr., Covington, LA 70433PHONE: 985-875-0800FAX: 1-985-809-5788Home HCFA-1500 Forms CMS-1500 Forms UB04 Forms UB-92/CMS-1450/HCFA-1450 Forms CMS 485,486,487 Forms Claim...Patient Request for Confidential... Patient Request for ConfidentialCommunications (Form #108) The patient may request alternate means of communication. For example, a patient may... request that they not be phoned at home or that mail be sent to an alternate address. In cases such as this, the patient will be asked to complete this form that requires...