Doctors Medical Receipt



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INCIDENT POSITION: Item Description (Print All Entries) Unit Amount Unit - list a measurable description of the item (gauge, gm, ml, bag, doz., etc.) Form distribution: (Use carbon paper) Original - Medical Supply Coordinator Copy - Source of Supply INCIDENT REIMBURSEMENT OF ANY SUPPLIES/EQUIPMENT WILL BE BASED ONLY UPON ORIGINAL FORM LISTINGS.

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It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change. | Charles Darwin