1 Part - 11" x 8.50" Form Size - Red Print Color - 2500 / Carton - View Complete Details
Product Number: TOP59870R
In Stock - Hurry, only 52 left.
Note: Must buy in quantities of 1 starting at 3.
Estimated Delivery 10 business day(s) - Fri 5/12 - The products will be shipped directly from the Manufacturer and will require additional time for delivery. 10 business days - Fri 5/12 - The products will be shipped directly from the Manufacturer and will require additional time for delivery.
This product was manufactured in the United States.
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.
Help out our customers.
Be the first to write a review.
Have a question about this product? Please click the button below to get started. Once you have posted your question we will submit it to our community of customers and with our own staff who have recent experience with the same product for their open and honest feedback.Ask a Question