{"product_id":"form-104-y","title":"Form 104-Y - Ledger and Treatment Record","description":"\u003cp\u003eLedger and Treatment Record\u003cbr\u003eSpace for all the information necessary to render the patient’s statement, including charges, payments, balance, caregiver’s name and initials\u003cbr\u003eFits 101 style envelopes and other folders\u003cbr\u003eBack is the same as front except without patient address, etc.\u003cbr\u003eSize 8.5” x 11\"\u003cbr\u003ePrinted 2 sides\u003cbr\u003eBlack ink on yellow index stock\u003cbr\u003e100 Per Package.\u003c\/p\u003e","brand":"4 Dental Docs","offers":[{"title":"Default Title","offer_id":48046885273858,"sku":null,"price":32.0,"currency_code":"USD","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0825\/9908\/4290\/files\/104-YLedgerandTreatmentRecords1.jpg?v=1782505555","url":"https:\/\/4dentaldocs.com\/products\/form-104-y","provider":"4 Dental Docs","version":"1.0","type":"link"}