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  • Claim Slip X-Ray

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    Joshua Mirandilla
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    Claim Slip X-ray

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    25 views4 pages

    Claim Slip X-Ray

    Uploaded by

    Joshua Mirandilla

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 4

    CLAIM SLIP CLAIM SLIP

    Patient’s name: _______________________________________ Patient’s name: _______________________________________

    Procedure: _______________________________________ Procedure: _______________________________________

    Date of exam: _______________________________________ Date of exam: _______________________________________

    File no.: _______________________________________ File no.: _______________________________________

    Claiming date: _______________________________________ Claiming date: _______________________________________

    Kindly bring valid ID when sending someone to pick up your result. Kindly bring valid ID when sending someone to pick up your result.

    THANK YOU! THANK YOU!

    CLAIM SLIP CLAIM SLIP

    Patient’s name: _______________________________________ Patient’s name: _______________________________________

    Procedure: _______________________________________ Procedure: _______________________________________

    Date of exam: _______________________________________ Date of exam: _______________________________________

    File no.: _______________________________________ File no.: _______________________________________

    Claiming date: _______________________________________ Claiming date: _______________________________________

    Kindly bring valid ID when sending someone to pick up your result. Kindly bring valid ID when sending someone to pick up your result.

    THANK YOU! THANK YOU!

    CLAIM SLIP CLAIM SLIP

    Patient’s name: _______________________________________ Patient’s name: _______________________________________

    Procedure: _______________________________________ Procedure: _______________________________________

    Date of exam: _______________________________________ Date of exam: _______________________________________

    File no.: _______________________________________ File no.: _______________________________________

    Claiming date: _______________________________________ Claiming date: _______________________________________

    Kindly bring valid ID when sending someone to pick up your result. Kindly bring valid ID when sending someone to pick up your result.

    THANK YOU! THANK YOU!

    CLAIM SLIP CLAIM SLIP

    Patient’s name: _______________________________________ Patient’s name: _______________________________________

    Procedure: _______________________________________ Procedure: _______________________________________

    Date of exam: _______________________________________ Date of exam: _______________________________________

    File no.: _______________________________________ File no.: _______________________________________

    Claiming date: _______________________________________ Claiming date: _______________________________________

    Kindly bring valid ID when sending someone to pick up your result. Kindly bring valid ID when sending someone to pick up your result.

    THANK YOU! THANK YOU!


    CLAIM SLIP CLAIM SLIP

    Patient’s name: _______________________________________ Patient’s name: _______________________________________

    Procedure: _______________________________________ Procedure: _______________________________________

    Date of exam: _______________________________________ Date of exam: _______________________________________

    File no.: _______________________________________ File no.: _______________________________________

    Claiming date: _______________________________________ Claiming date: _______________________________________

    Kindly bring valid ID when sending someone to pick up your result. Kindly bring valid ID when sending someone to pick up your result.

    THANK YOU! THANK YOU!

    CLAIM SLIP CLAIM SLIP

    Patient’s name: _______________________________________ Patient’s name: _______________________________________

    Procedure: _______________________________________ Procedure: _______________________________________

    Date of exam: _______________________________________ Date of exam: _______________________________________

    File no.: _______________________________________ File no.: _______________________________________

    Claiming date: _______________________________________ Claiming date: _______________________________________

    Kindly bring valid ID when sending someone to pick up your result. Kindly bring valid ID when sending someone to pick up your result.

    THANK YOU! THANK YOU!

    CLAIM SLIP CLAIM SLIP

    Patient’s name: _______________________________________ Patient’s name: _______________________________________

    Procedure: _______________________________________ Procedure: _______________________________________

    Date of exam: _______________________________________ Date of exam: _______________________________________

    File no.: _______________________________________ File no.: _______________________________________

    Claiming date: _______________________________________ Claiming date: _______________________________________

    Kindly bring valid ID when sending someone to pick up your result. Kindly bring valid ID when sending someone to pick up your result.

    THANK YOU! THANK YOU!

    CLAIM SLIP CLAIM SLIP

    Patient’s name: _______________________________________ Patient’s name: _______________________________________

    Procedure: _______________________________________ Procedure: _______________________________________

    Date of exam: _______________________________________ Date of exam: _______________________________________

    File no.: _______________________________________ File no.: _______________________________________

    Claiming date: _______________________________________ Claiming date: _______________________________________

    Kindly bring valid ID when sending someone to pick up your result. Kindly bring valid ID when sending someone to pick up your result.

    THANK YOU! THANK YOU!


    CLAIM SLIP CLAIM SLIP

    Patient’s name: _______________________________________ Patient’s name: _______________________________________

    Procedure: _______________________________________ Procedure: _______________________________________

    Date of exam: _______________________________________ Date of exam: _______________________________________

    File no.: _______________________________________ File no.: _______________________________________

    Claiming date: _______________________________________ Claiming date: _______________________________________

    Kindly bring valid ID when sending someone to pick up your result. Kindly bring valid ID when sending someone to pick up your result.

    THANK YOU! THANK YOU!

    CLAIM SLIP CLAIM SLIP

    Patient’s name: _______________________________________ Patient’s name: _______________________________________

    Procedure: _______________________________________ Procedure: _______________________________________

    Date of exam: _______________________________________ Date of exam: _______________________________________

    File no.: _______________________________________ File no.: _______________________________________

    Claiming date: _______________________________________ Claiming date: _______________________________________

    Kindly bring valid ID when sending someone to pick up your result. Kindly bring valid ID when sending someone to pick up your result.

    THANK YOU! THANK YOU!

    CLAIM SLIP CLAIM SLIP

    Patient’s name: _______________________________________ Patient’s name: _______________________________________

    Procedure: _______________________________________ Procedure: _______________________________________

    Date of exam: _______________________________________ Date of exam: _______________________________________

    File no.: _______________________________________ File no.: _______________________________________

    Claiming date: _______________________________________ Claiming date: _______________________________________

    Kindly bring valid ID when sending someone to pick up your result. Kindly bring valid ID when sending someone to pick up your result.

    THANK YOU! THANK YOU!

    CLAIM SLIP CLAIM SLIP

    Patient’s name: _______________________________________ Patient’s name: _______________________________________

    Procedure: _______________________________________ Procedure: _______________________________________

    Date of exam: _______________________________________ Date of exam: _______________________________________

    File no.: _______________________________________ File no.: _______________________________________

    Claiming date: _______________________________________ Claiming date: _______________________________________

    Kindly bring valid ID when sending someone to pick up your result. Kindly bring valid ID when sending someone to pick up your result.

    THANK YOU! THANK YOU!


    CLAIM SLIP CLAIM SLIP

    Patient’s name: _______________________________________ Patient’s name: _______________________________________

    Procedure: _______________________________________ Procedure: _______________________________________

    Date of exam: _______________________________________ Date of exam: _______________________________________

    File no.: _______________________________________ File no.: _______________________________________

    Claiming date: _______________________________________ Claiming date: _______________________________________

    Kindly bring valid ID when sending someone to pick up your result. Kindly bring valid ID when sending someone to pick up your result.

    THANK YOU! THANK YOU!

    CLAIM SLIP CLAIM SLIP

    Patient’s name: _______________________________________ Patient’s name: _______________________________________

    Procedure: _______________________________________ Procedure: _______________________________________

    Date of exam: _______________________________________ Date of exam: _______________________________________

    File no.: _______________________________________ File no.: _______________________________________

    Claiming date: _______________________________________ Claiming date: _______________________________________

    Kindly bring valid ID when sending someone to pick up your result. Kindly bring valid ID when sending someone to pick up your result.

    THANK YOU! THANK YOU!

    CLAIM SLIP CLAIM SLIP

    Patient’s name: _______________________________________ Patient’s name: _______________________________________

    Procedure: _______________________________________ Procedure: _______________________________________

    Date of exam: _______________________________________ Date of exam: _______________________________________

    File no.: _______________________________________ File no.: _______________________________________

    Claiming date: _______________________________________ Claiming date: _______________________________________

    Kindly bring valid ID when sending someone to pick up your result. Kindly bring valid ID when sending someone to pick up your result.

    THANK YOU! THANK YOU!

    CLAIM SLIP CLAIM SLIP

    Patient’s name: _______________________________________ Patient’s name: _______________________________________

    Procedure: _______________________________________ Procedure: _______________________________________

    Date of exam: _______________________________________ Date of exam: _______________________________________

    File no.: _______________________________________ File no.: _______________________________________

    Claiming date: _______________________________________ Claiming date: _______________________________________

    Kindly bring valid ID when sending someone to pick up your result. Kindly bring valid ID when sending someone to pick up your result.

    THANK YOU! THANK YOU!

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