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TOPS UB-04 Continuous Forms

1 Part - 11" x 9.50" Form Size - White - Red Print Color - 2500 / Carton
Product Number: TOP59770R
  • 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"
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Product Description

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.

  • 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"
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Product Specifications

  • Assembly Required
    No
  • Binding Type
    Perforated
  • Brand Name
    Tops
  • Country of Origin
    United States
  • Environmental Certification
    Sustainable Forestry Initiative (SFI)
  • Environmentally Friendly
    Yes
  • Form Length
    11"
  • Form Size (W x H)
    8 1/2 in x 11 in
  • Form Width
    9.50"
  • Format
    Continuous Form Continuous Form
  • Global Product Type
    Forms-Insurance Claim
  • Layout
    One Form per Sheet One Form per Sheet
  • Manufacturer
    Tops
  • Manufacturer Part Number
    59770R
  • Manufacturer Website Address
    www.tops-products.com
  • Marketing Information
    UB-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.
  • Number of Parts
    1
  • Packaged Quantity
    2500 / Carton
  • Packaging
    2500
  • Paper Color(s)
    Red White
  • Paper Stock
    20-lb.
  • Post-Consumer Recycled Content Percent
    0 %
  • Pre-Consumer Recycled Content Percent
    0 %
  • Print Color
    Red
  • Print Technology
    Dot Matrix
  • Print and Ruling Color(s)
    Red
  • Printer Compatibility
    Dot Matrix
  • Product Color
    White
  • Product Line
    Continuous UB-04 Forms
  • Product Model
    UB-04
  • Product Name
    UB-04 Continuous Forms
  • Product Type
    Claim Form
  • Punching
    Dot Matrix Holes
  • Recycled
    No
  • Refurbished
    N
  • Sheet Size
    9 1/2" x 11"
  • Total Recycled Content Percent
    0 %

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