{"product_id":"form-104-1w","title":"Form 104-1W - Ledger and Treatment Record","description":"\u003cp\u003eLedger and Treatment Record\u003cbr\u003eAdditional space for services rendered, for those who prefer one column for posting fees\u003cbr\u003eBack is same as front except without patient address, etc.\u003cbr\u003eHas space for caregiver’s name and initials\u003cbr\u003eSize 8.5” x 11\"\u003cbr\u003ePrinted 2 sides\u003cbr\u003eGrey ink on white index stock\u003cbr\u003e100 Per Package.\u003cbr\u003e\u003c\/p\u003e","brand":"4 Dental Docs","offers":[{"title":"Default Title","offer_id":48046879113474,"sku":null,"price":32.0,"currency_code":"USD","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0825\/9908\/4290\/files\/104-1WLedgerandTreatmentRecords1.jpg?v=1782504902","url":"https:\/\/4dentaldocs.com\/products\/form-104-1w","provider":"4 Dental Docs","version":"1.0","type":"link"}