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TOPS UB-04 Hospital Claim Form 1 Part - 11" x 8.50" Form Size - 2500 / Carton

Item #: TOP59870R
List Price $198.36 Your Price $115.21 / CT You Save $83.15 - 42%
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Product Description

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.

General Information

General Information

ManufacturerTOPS Products
Manufacturer Part Number59870R
Manufacturer Website Addresshttp://www.tops-products.com
Brand NameTOPS
Product ModelUB-04
Product NameUB-04 Hospital Claim Form
Packaged Quantity2500 / Carton
Product TypeClaim Form

Product Information

Media Quantity(1 Form Per Sheet)
Form Size11" Length x 8.50" Width
Number of Parts1 Part
PrintFront Side Form With Red Ink
Print TechnologyLaser

Physical Characteristics



Certifications & Standards

American Medical Association

Recycled Content0%
Assembly RequiredNo
Green CompliantYes
Green Compliance Certificate/AuthoritySFI
Country of OriginUnited States


Customer Reviews

Customer Reviews

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