|
Forms
are for private use within a physician's office
only.
These forms may not be redistributed
without the express
written consent of the Inga
Ellzey Practice Group, Inc.
 Click
the Adobe Reader icon to download the latest version
of Adobe Acrobat for free!
|
Form |
Acrobat .pdf version |
Microsoft Word |
|
|
|
|
|
Insurance Claim Filing Waiver |
Click
here |
Click
here |
|
|
|
|
|
Skin Cancer Screening Form |
Click
here |
Click
here |
|
Nine Critical Contact Points to Cash Flow |
Click
here |
|
Billing Reports (use the 3 links below)
(from page 4 of July/August 2009 etc.
Newsletter) |
use 3 links
below |
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Practice At a Glance Spreadsheet (billing performance information) |
Excel
Click
here |
|
|
Practice At a Glance Instructions |
Click
here |
|
|
Estimate Your Current Billing Expenses |
Click
here |
|
|
|
|
|
|
Patient Questionnaire Survey |
Click
here |
Click
here |
|
Financial Hardship Form |
Click
here |
Click
here |
|
Quickie Check-in Form |
|
Click
here |
|
Financial Policy |
|
Click
here |
|
Nurse Checkup Form |
Click
here |
Click
here |
|
Nail Trimming Information |
Click
here |
|
|
New ABN Forms - Effective September 1, 2008 |
Click
here |
Click
here |
|
New ABN Forms - Spanish Version |
Click
here |
Click
here |
|
Managed
Care (Non-Medicare) Waiver Form |
Click
here |
Click
here |
|
Patient Discharge Letter |
Click
here |
Click
here |
|
Benign Lesion Documentation Form |
Click
here |
|
|
Insurance Pre-Verification Form |
Click
here |
Click
here |
Click
the Adobe Reader icon to download the latest version
of Adobe Acrobat for free!
Forms
are for private use within a physician's office
only.
These forms may not be redistributed
without the express
written consent of the Inga
Ellzey Practice Group, Inc. |
