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TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton. Picture 1 TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton. Picture 2
TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton. The main picture.
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Product ID: 129942
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TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton
TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton. Picture 1 TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton. Picture 2
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Estimated delivery between Jun 24 - Jun 30
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Details
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.
Specifications
  • Number of Parts
    1
  • Print Color
    Red
  • Print Technology
    Laser
  • Manufacturer Website Address
    http://www.tops-products.com
  • Product Name
    1-part UB-04 Laser-cut Forms
  • Type
    Claim Form
  • Recycled
    No
  • Model
    UB-04
  • Certifications & Standards
    American Medical Association
  • General Item Color
    White
  • Length
    11"
  • Width
    8.50"
  • Number of Forms per Sheet
    1
  • Printed Side
    Front
  • Environmental Certification
    Sustainable Forestry Initiative (SFI)
  • Commercial Use Type
    Not Provided
  • Show more
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