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TOPS UB-04 Continuous Forms
Product Number: TOP59770R
Sold Out
This product is sold out and we do not know when we will be getting another shipment. We apologize for any inconvenience this may cause.
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Product Description
TOPS UB-04 Continuous Forms
1 Part - 11" x 9.50" Form Size - White - Red Print Color - 2500 / Carton
Description:
UB-04 continuous forms are designed for hospitals 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). Continuous forms are printed on 20 lb. bond paper.
- UB-04 1-part continuous is a form that hospitals use to file a claim with the patient's insurance company
- Forms are printed to GPO standards in OCR ink on 20 lb. bond
- Health Care Finance Administration format ensures accuracy in reporting all necessary information
- 9-1/2" x 11"
Product Specifications
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Assembly RequiredNo
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Binding TypePerforated
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Brand NameTops
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Country of OriginUnited States
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Environmental CertificationSustainable Forestry Initiative (SFI)
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Environmentally FriendlyYes
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Form Length11"
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Form Size (W x H)8 1/2 in x 11 in
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Form Width9.50"
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FormatContinuous Form Continuous Form
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Global Product TypeForms-Insurance Claim
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LayoutOne Form per Sheet One Form per Sheet
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ManufacturerTops
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Manufacturer Part Number59770R
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Manufacturer Website Addresswww.tops-products.com
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Marketing InformationUB-04 continuous form is designed for hospitals to file a claim with the patient's insurance company. Forms are printed to Government Printing Office standards in OCR ink on 20 lb bond.
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Number of Parts1
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Packaged Quantity2500 / Carton
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Packaging2500
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Paper Color(s)Red White
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Paper Stock20-lb.
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Post-Consumer Recycled Content Percent0 %
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Pre-Consumer Recycled Content Percent0 %
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Print ColorRed
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Print TechnologyDot Matrix
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Print and Ruling Color(s)Red
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Printer CompatibilityDot Matrix
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Product ColorWhite
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Product LineContinuous UB-04 Forms
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Product ModelUB-04
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Product NameUB-04 Continuous Forms
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Product TypeClaim Form
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PunchingDot Matrix Holes
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RecycledNo
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RefurbishedN
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Sheet Size9 1/2" x 11"
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Total Recycled Content Percent0 %