.jpg)
TOPS 1-part UB-04 Laser-cut Forms
SKU: TOP59870R JS-209111
TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton
Pack/Pack : 2500
| Volume Discounts | |
|---|---|
| Quantity | Price |
| Buy 1 or more | $223.82 |
In Stock
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
Packaged Quantity: 2500 / Carton
Product Type: Claim Form
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
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
Product Color: White
Product Color: White
Miscellaneous
Certifications & Standards:
Recycled: No
Assembly Required: No
Country of Origin: United States
Environmental Certification: Sustainable Forestry Initiative (SFI)
Certifications & Standards:
American Medical Association
Recycled: No
Assembly Required: No
Country of Origin: United States
Environmental Certification: Sustainable Forestry Initiative (SFI)
