ACCOUNTING SUBMISSION FORM
Notice to Accounting Form
Complete this form to notify accounting if you will be completing a debit transaction or series of transactions totaling $5,000 or more in a day. Examples of this would be a Patient Credit Card Refund, a Patient Care Credit or other Finance Refund, or a large ACH/Debit card office purchase.
If you have questions or difficulty using the form, please email email@example.com