top of page
TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red
SKU TOP59870R
Price
$312.26
Excluding Sales Tax
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
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 InformationManufacturer: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
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 InformationNumber 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
Form Length:11"
Form Width:8.50"
Number of Parts:1
Printed Side:Front
Print Color:Red
Print Technology:Laser
Physical CharacteristicsColor Family:White
Product Color:White
Product Color:White
MiscellaneousCertifications & Standards:
Recycled:No
Assembly Required:No
Country of Origin:United States
Environmental Certification:Sustainable Forestry Initiative (SFI)
American Medical Association
Recycled:No
Assembly Required:No
Country of Origin:United States
Environmental Certification:Sustainable Forestry Initiative (SFI)
Quantity
bottom of page