1 Part - 11" x 9.50" Form Size - Red Print Color - 2500 / Carton - View Complete Details
Product Number: TOP59770R
In Stock - Hurry, only 24 left.
Note: Must buy in quantities of 1 starting at 3.
Estimated Delivery - 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 UB-04 Hospital Claim Form - 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.View Product Specs
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