TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton
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Estimated delivery between Apr 30 - May 2
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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.
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Number of Parts
1
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Print Color
Red
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Print Technology
Laser
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Manufacturer
TOPS Products
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Manufacturer Part Number
59870R
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Manufacturer Website Address
http://www.tops-products.com
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Product Name
1-part UB-04 Laser-cut Forms
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Packaged Quantity
2500 / Carton
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Type
Claim Form
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Recycled
No
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Assembly Required
No
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Country of Origin
United States
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Model
UB-04
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Certifications & Standards
American Medical Association
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General Item Color
White
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Length
11"
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Width
8.50"
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Number of Forms per Sheet
1
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Printed Side
Front
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Environmental Certification
Sustainable Forestry Initiative (SFI)
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Commercial Use Type
Not Provided
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