TOPS UB-04 Continuous Forms

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TOPS UB-04 Continuous Forms

1 Part - 11" x 9.50" Form Size - Red Print Color - 2500 / Carton - View Complete Details

Product Number: TOP59770R

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TOPS UB-04 Continuous Forms
1 Part - 11" x 9.50" Form Size - Red Print Color - 2500 / Carton

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Estimated Delivery - 1 business day(s) - Tue 12/12 2 business days - Wed 12/13

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Made in
America
Made in America

This product was manufactured in the United States.

TOPS UB-04 Continuous Forms - 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.

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