Tops UB-04 Hospital Claim Form - 2500 per carton TOP59870R + Click to enlarge

Tops UB-04 Hospital Claim Form - 2500 per carton

1 Part - 11" x 8.50" Form Size - 2500 / Carton

Reg. Price $211.25
Our Price $117.08
Per Carton

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UB-04 laser-cut forms are designed for medical offices to file a claim with the patient's insurance company. The Health Care Finance Administration format ensures accuracy in reporting all necessary information. Forms meet the requirements of the Centers for Medicare and Medicaid Services (CMS). Forms are printed on 20 lb. bond paper.

SKU
TOP59870R
Manufacturer
Tops Products
Manufacturer Part Number
59870R
Brand Name
Tops
Product Model
UB-04
Packaged Quantity
2500 / Pack
Product Type
Claim Form
Color
White
Form Size
11" Length x 8.50" Width
Number of Parts
1 Part
Print
Front Side Form With Red Ink
Print Technology
Laser
Certifications & Standards

American Medical Association

Recycled
No
Green Compliant
Yes
Green Compliance Certificate/Authority
SFI