Tops TOP 59870R Tops 1-part Ub-04 Laser-cut Forms - 1 Part - 11 X 8.50 Form Size - White - Red Print Color - 2500 Carton

SKU: WE54ZG7INQ | Mfg. Part: TOP 59870R | UPC: 025932598708 | 2 reviews | Share

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UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total

General Information

Manufacturer:TOPS Products
Manufacturer Part Number:59870R
Manufacturer Website Address:http://www.tops-products.com
Brand Name:TOPS
Product Model:UB-04
Product Name:1-part UB-04 Laser-cut Forms
Marketing Information:

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.

Packaged Quantity:2500 / Carton
Product Type:Claim Form

Product Information

Number of Forms per Sheet:1
Form Length:11"
Form Width:8.50"
Number of Parts:1
Printed Side:Front
Print Color:Red
Print Technology:Laser

Physical Characteristics

Color:White

Miscellaneous

Certifications & Standards:

American Medical Association

Recycled:No
Assembly Required:No
Environmentally Friendly:Yes
Environmental Certification:SFI
Country of Origin:United States