10 HEALTHCARE FORMS Dental Claim Forms 1-Part Item No. Description Paper Size Color Per carton Weight VWH-HCF4-HC26 Laser (2024) ADA White 81⁄ 2˝ x 11˝ Black 2500 30 Lbs VWH-HCF5-HC26 Laser (2024) Red ADA White 81⁄ 2˝ x 11˝ OCR Red 2500 30 Lbs 2-Part Item No. Description Paper Size Color Per Carton Weight VWH-HCF2-HC26* Continuous CMS-1450 White/White 91⁄ 2˝ x 11˝ OCR Red 1000 22 Lbs Claim Forms 1-Part Item No. Description Paper Size Color Per Carton Weight VWH-HCF1-HC26* Continuous CMS-1450 White 91⁄ 2˝ x 11˝ OCR Red 2500 30 Lbs VWH-HCF3-HC26* Laser CMS-1450 White 81⁄ 2˝ x 11˝ OCR Red 2500 30 Lbs VWH-HCF6-HC26 Continuous CMS 1500 (02/12) White 91⁄ 2˝ x 14˝ OCR Red 2500 30 Lbs VWH-HCF9-HC26 Laser CMS 1500 (02/12) White 81⁄ 2˝ x 11˝ OCR Red 2500 27 Lbs Note: Healthcare claim forms (AL) are designed for use in the state of Alabama with a lower right corner cut. *Revised to include NPI. 1-Part Item No. Description Paper Face Size Per Carton Weight RHF1-HCF17-HC26 Generic Laser Statements White Blue 8 1/2" x 11" 2000 27 Lbs RHF1-HCF10-HC26 Generic Laser Statements White Blue 8 1/2" x 11" 2000 27 Lbs RHF1-HCF11-HC26 Generic Laser Statements, MC/VISA White Blue 8 1/2" x 11" 2000 27 Lbs RHF1-HCF18-HC26 Generic Laser Statements White Blue 8 1/2" x 11" 2000 27 Lbs RHF1-HCF19-HC26 Generic Laser Statements White Blue 8 1/2" x 11" 2000 27 Lbs RHF1-HCF12-HC26 Generic Laser Statements, MC/VISA/DISC White Burgundy 8 1/2" x 11" 2000 27 Lbs RHF1-HCF13-HC26 Generic Laser Statements, MC/VISA White Burgundy 8 1/2" x 11" 2000 27 Lbs RHF1-HCF14-HC26 Generic Laser Statements, MC/VISA/DISC White Blue 8 1/2" x 11" 2000 27 Lbs RHF1-HCF15-HC26 Generic Laser Statements, MC/VISA White Blue 8 1/2" x 11" 2000 27 Lbs RHF1-HCF16-HC26 Generic Laser Statements White Burgundy 8 1/2" x 11" 2000 27 Lbs RHF1-HCF20-HC26 Generic Laser Statements, MC/VISA White Blue 8 1/2" x 11" 2000 27 Lbs Medical Laser Billing Statements 1-Part Item No. Description EIS-O22-FK-HC26 Dbl Window Envelope, Self-Seal, No service endorsement (also available as imprinted for service endorsement option) VWH-B84-B-HC26 Dbl Window Envelope, Gum Seal, No service endorsement (also available as imprinted for service endorsement option) EIS-I1-FK-HC26 White Inserted envelope set EIS-I1-FK-HC26 Blue Inserted envelope set EIS-I1-FK-HC26 Canary Inserted envelope set EIS-I1-FK-HC26 Grey Inserted envelope set EIS-I1-FK-HC26 Ivory Inserted envelope set EIS-I1-FK-HC26 Green Inserted envelope set Envelopes Also available imprinted NEW! NEW! NEW! NEW!
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