ADVANCE DIRECTIVE LIVING WILL__ HEALTH CARE PROXY__ DURABLE POWER OF ATTORNEY FOR HEALTH CARE__ OTHER__ (1) ADVANCED DIRECTIVE LIVING WILL__ HEALTH CARE PROXY__ DURABLE POWER of ATTORNEY FOR HEALTH CARE__ OTHER__ (1) ALERTS DIABETIC/HEART CONDITION/ON ANTICOAGULANTS/COUMADIN PATIENT/PACEMAKER/NO EPINEPHRINE/MITRAL VALVE PROLAPSE/NAME (1) ALLERGIC (1) ALLERGIC TO LATEX (1) ALLERGIC TO PENICILLIN (1) ALLERGIC TO: (2) ALLERGIC TO: (Wrap-around) (1) ALLERGIC TO: CODEINE/SULFA/PENICILLIN (1) ALLERGIC TO: / ALLERGY (Wrap-around) (1) ALLERGIC TO: PENICILLIN/CODEINE/SULFA (1) ALLERGIES (1) ALLERGIES []LATEX [] DYE [] TAPE [] OTHER.... (1) ALLERGIES/DRUG REACTIONS (1) ALLERGIES/DRUG REACTIONS NO KNOWN ALLERGIES (1) ALLERGY / ALLERGIC TO: (1) ALLERGY ALERT (1) ALLERIC TO: (Wrap-around) (1) ALLERIC: _____ (1) ATTENTION OFFICE STAFF: CO-PAY $__ COLLECT AT TIME OF VISIT (2) BC/BS (1) BILLS ARE DUE IN 30 DAYS (1) BLUE CROSS (1) BLUE SHIELD (1) CAUTION: YOUR ACCOUNT IS NOW 90 DAYS PAST DUE. PAY NOW AND AVOID COLLECTION ACTION. (1) CHART INACTIVATED *MOVED/UNABLE TO CONTACT *TRANSFERRED TO ANOTHER DOCTOR *NON-PAYMENT *MISSED APPOINTMENTS *NO RESPONS (1) Children's Sticker Unit - Specify Which 5 Sticker Rolls (1) CONFIDENTIAL (1) CONFIDENTIAL FOR AUTHORIZED PERSONNEL ONLY (1) CO-PAY ___ (1) DIABETIC (2) DNR (1) DOCUMENTATION ATTACHED DO NOT SEPARATE FROM CLAIM (1) FINAL NOTICE *THIS IS THE LAST STATEMENT THAT WILL BE SENT TO YOU. *REMIT PAYMENT IN FULL TODAY! *WE ACCEPT VISA & M (1) FINAL NOTICE IF WE DO NOT RECEIVE YOUR PAYMENT BY ___ WE WILL BE FORCED TO TURN YOUR ACCOUNT OVER FOR COLLECTION. (1) FINAL NOTICE *YOUR INSURANCE HAS PAID ITS SHARE. *IF WE DO NOT HEAR FROM YOU WITHIN___DAYS, THIS ACCOUNT WILL BE TURNED (1) FINAL NOTICE IF WE DO NOT HEAR FROM YOU WITHIN 10 DAYS, THIS ACCOUNT WILL BE TURNED OVER TO OUR COLLECTION AGENCY. (1) FINAL NOTICE! (2) FOR YOUR CONVENIENCE, YOU MAY TRANSFER THIS BALANCE TO YOUR CREDIT CARD ACCOUNT. TO PAY WITH YOUR CREDIT CARD, PLEASE C (1) FRIENDLY REMINDER THIS ACCOUNT IS PAST DUE. YOUR PROMPT ATTENTION IS COURTEOUSLY REQUESTED. (1) GREAT CHECKUP (1) HIPAA (1) HIPAA REQUIREMENTS PRIVACY NOTICE:GIVEN TO PATIENT__ ACKNOWLEDGEMENT RECEIVED__AUTHORIZATION/OTHER: DISCLOSURE AUTHORIZ (1) HMO (1) HMO DO YOU HAVE AUTHORIZATION? (1) HMO/PPO (1) HUMANA (1) HYPERTENSION (1) I GREW THIS MUCH (1) ICE Card Counter Display (1) ICE Card Display with Label and Placard (1) ICE Medical Alert Card (1) IF YOU ARE UNABLE TO PAY IN FULL PLEASE SEND A PARTIAL PAYMENT (1) I'M A PRINCESS (1) I'M CAVITY FREE (1) I'M HEALTHY (1) INSURANCE (1) INSURANCE (Wrap-around) (1) INSURANCE PROVIDER: (1) JUST A FRIENDLY REMINDER THAT YOUR ACCOUNT IS OVERDUE. WON'T YOU PLEASE MAIL YOUR REMITTANCE? (1) Laser/Inkjet Label Sheets (1) MAY WE HELP YOU? WE ARE WILLING TO MAKE ARRANGEMENTS FOR REGULAR PAYMENTS TO CLEAR UP THIS BALANCE. PLEASE CALL OR STO (1) MED Card (1) MED Card Counter Display (1) MED Card Display with Label and Placard (1) MEDICAID (1) MEDICAID (Wrap-around) (1) MEDI-CAL (1) MEDICAL ALERT (3) MEDICAL ALERT / MEDICAL ALERT (Wrap-around) (1) MEDICAL HISTORY UPDATE (With Fill in Boxes) (1) MEDICARE (1) MEDICARE (Wrap-around) (1) MEDICARE HMO (1) MEDICATION ALLERGY (1) MINOR (1) MISSED APPOINTMENT ON (1) NAME ALERT (1) NAME ALERT D.O.B._____ (1) NAME ALERT DATE OF BIRTH__ TWO PATIENTS WITH SAME NAME (1) NAME ALERT / BIRTHDATE___ (1) NAME ALERT / TWO PATIENTS WITH SAME NAME (1) NAME ALERT/TWO PATIENTS WITH SAME NAME / NAME ALERT (Wrap-around) (1) NEW INSURANCE COVERAGE? NOTIFY US IMMEDIATELY IF YOUR INSURANCE HAS CHANGED. SEND US THE ID AND GROUP #'S, PHONE NUMBE (1) NO INSURANCE (1) NO KNOWN ALLERGIES (1) PAST DUE *YOUR INSURANCE HAS PAID ITS SHARE. *DON'T JEPORIDIZE YOUR CREDIT. *PLEASE REMIT TODAY! (1) PAST DUE PROMPT PAYMENT OF THIS BALANCE DUE WILL PRESERVE YOUR GOOD CREDIT RATING. MAIL YOUR CHECK TODAY. (1) PAST DUE WE ACCEPT VISA AND MASTERCARD. CALL OUR OFFICE WITH YOUR CARD NUMBER. (1) PAST DUE PLEASE CONTACT US AT ONCE REGARDING YOUR OVERDUE ACCOUNT (1) PAST DUE PLEASE REMIT TODAY! (1) PATIENT RECORD CONFIDENTIAL (1) PATIENT RESPONSIBILITY DUE TO: *DEDUCTIBLE *NONCOVERED SERVICES *TOO MANY SERVICES IN TIME PERIOD *MAXIUMUM BENEFIT ALLO (1) PAYMENT HAS NOT BEEN RECEIVED FROM YOUR INSURANCE COMPANY. THIS AMOUNT IS NOW DUE FROM YOU. PLEASE REMIT OR CONTACT US (1) PLEASE CONTACT OUR OFFICE REGARDING YOUR OVERDUE BALANCE. WE'D LIKE TO WORK WITH YOU TO DEVELOP A REASONABLE PAYMENT P (1) PLEASE NOTE THIS ACCOUNT IS PAST DUE. YOUR PROMPT ATTENTION IS COURTEOUSLY REQUESTED. (1) PLEASE PROCESS THIS CLAIM AS: *REBILL *CORRECTIONS HAVE BEEN MADE *FIRST CLAIM NOT RECEIVED *SECONDARY INS. EOB ATTACHED (1) PLEASE… HAVING TO ASK A GOOD PATIENT FOR PAYMENT IS NOT A PLEASANT TASK: HOWEVER, YOUR REMITTANCE WOULD BE GREATLY APP (1) PLEASE… LET US KNOW IF YOU HAVE INSURANCE COVERAGE FOR THESE SERVICES. IF NOT, THE BALANCE SHOWN IS NOW DUE. (1) PREMEDICATE (1) PRE-MEDICATE (1) PRIMARY CARE PHYSICIAN: DR.___ (1) PRIOR APPROVAL REQUIRED (1) REFERRAL NEEDED (1) REGULAR MONTHLY PAYMENTS ARE NECESSARY TO KEEP THIS ACCOUNT CURRENT (1) REGULAR PAYMENTS MUST BE MADE EVERY MONTH IN ORDER TO MAINTAIN GOOD CREDIT. (1) RESUBMISSION: THIS IS NOT A DUPLICATE BILING. THIS CLAIM HAS EITHER BEEN DENIED OR NEVER RECEIVED. PLEASE CONSIDER FO (1) RH NEGATIVE (1) RUSH (1) SECOND NOTICE THIS ACCOUNT IS PAST DUE. PLEASE REMIT PAYMENT TODAY. IF PAYMENT HAS BEEN MADE, PLEASE DISREGARD THIS NO (1) SELF PAY (1) SIGN HERE - With Arrow (1) STAR PATIENT (1) STAT (1) SUPESTAR PATIENT (1) THANK YOU FOR YOUR RECENT PAYMENT ON YOUR ACCOUNT. WE TRUST YOU WILL CONTINUE THESE REMITTANCES UNTIL THE ACCOUNT IS PA (1) THANK YOU! (1) THIS BALANCE IS OVERDUE! PROMPT PAYMENT WILL AVOID COLLECTION PROCEDURES. (1) THIS BALANCE IS YOUR INSURANCE CO-PAY. PLEASE PAY IN FULL. (1) THIS BALANCE MAY BE TRANSFERRED TO YOUR VISA OR MASTERCARD JUST CALL US (1) TOAD-ALLY GREAT (1) WE ACCEPT VISA AND MASTERCARD. IF YOU WISH TO PAY YOUR ACCOUNT WITH YOUR CREDIT CARD, PLEASE COMPLETE THE FOLLOWING LIN (1) WE HATE TO KEEP HOUNDING YOU, BUT YOUR BILL IS PAST DUE. (1) WE HAVE NOT BEEN PAID ON THIS CLAIM BECAUSE YOUR INSURANCE COMPANY: *SENT PAYMENT TO YOU *APPLIED THESE CHARGES TO YOUR (1) WORKER'S COMP (1) X-RAY NAME:__ NO.__ DATE:__ TAKEN BY:__ KV:__ EXP:__ COMMENTS:__ (1) X-RAYS HANDLE WITH CARE (1) YOUR ACCOUNT IS PAST DUE. WE WOULD APPRECIATE YOUR PAYMENT TODAY! (1) YOUR BALANCE AFTER INSURANCE RESPONSE IS $___ THANK YOU FOR PROMPT PAYMENT. (1) YOUR BALANCE DUE TO: *YOUR DEDUCTIBLE *NON-COVERED SERVICES *CO-PAY $___ (1) YOUR INSURANCE CO. HAS NOT PAID THIS CLAIM BECAUSE: *DEDUCTIBLE TAKEN *NONCOVERED SERVICE *INSURANCE CANCELED *REQUESTE (1) YOUR INSURANCE COMPANY HAS ALREADY PAID ITS SHARE OF YOUR BILL. THIS STATEMENT IS FOR THE AMOUNT YOU OWE. (1) YOUR INSURANCE COMPANY HAS PAID ITS SHARE OF YOUR BILL. THIS STATEMENT IS FOR THE AMOUNT PAYABLE DIRECTLY BY YOU. (1) YOUR INSURANCE COMPANY HAS PAID ITS SHARE OF YOUR BILL. THIS STATEMENT IS FOR THE AMOUNT PAYABLE DIRECTLY BY YOU. PLEA (1) YOUR INSURANCE COMPANY STATES THIS BALANCE IS YOUR RESPONSIBILITY. PLEASE REMIT TODAY! (1)

FLUORESCENT CHARTREUSE (7) FLUORESCENT GREEN (6) FLUORESCENT ORANGE (7) FLUORESCENT PINK (6) FLUORESCENT RED (11) FLUORESCENT YELLOW (3) GREEN (2) LIGHT BLUE (5) PINK (1) RED (4) WHITE (3) WHITE & BLUE (1) WHITE & RED (3) YELLOW (1)

1-3/4" CIRCLE (1) 1-3/4"W x 3-1/4"H (1) 13-1/2"W x 4"H (1) 1-5/8"W x 7/8"H (3) 1-7/8"W x 3/4"H (1) 2"W x 2"H (2) 2-1/2"W x 2-1/2"H (2) 2-1/2"W x 3/4"H (1) 2-1/4"W x 7/8"H (2) 2-1/8" H x 3-3/8" W (1) 3"W x 1"H (5) 3"W x 1-1/8"H (1) 3"W x 7/8"H (1) 3/4"H x 1-1/2"W (1) 3-1/4"W x 1-3/4"H (8) 4"W x 2"H (1) 4"W x 2-1/2"H (2) 4"W x 2-5/8"H (1) 5-1/2"W x 1"H (1) 6-1/2"W x 1"H (2) 9-1/4" H x 2-3/4" W x 3-1/4" D (1)

240/ROLL (2) 250/ROLL (10) 300/ROLL (1) 320/PACK (1) 320/ROLL (2) 390/ROLL (2) 4 PACKS/BOX (1) 420/ROLL (2) 5 ROLLS/UNIT (1) 500/ROLL (6) 560/ROLL (1) EMPTY (1)