Medical Forms*TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2″ X 11″, 2500/Carton (59770R
$128.99
The UB-04 is the form hospitals and institutions use to file a medical claim with the patient’s insurance company
- Revised Format
- AMA approved format
- Use TOPS UB-04 forms with confidence
- They meet the requirements of the Centers for Medicare and Medicaid Services (CMS) and are available in Laser and Continuous formats
- Made in the USA
| Attribute name | Attribute value |
|---|---|
| Length in Inches | 2500 |
| Number of Parts The physical dimensions of the form. | 8 1/2″ x 11″ |
| Width in Inches Items of a particular grouping, as merchandised and labeled by a manufacturer | UB04 Health Care Form |
| Medical Form Type Actual manufacturer name for the color of the product. | White |
| Print Type | Continuous |
Be the first to review “Medical Forms*TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2″ X 11″, 2500/Carton (59770R”
Related products
Construction Paper
Construction Paper*Crayola Construction Paper Sheets, Assorted Colors, 48/Pack (99-0036)
Copy & Printer Paper
Copy & Printer Paper
Multipurpose Paper*JAM Paper 12″ x 18″ Multipurpose Paper, Midnight Black, 50/Pack (1218-P-B-50)
Copy & Printer Paper
Copy & Printer Paper
Copy & Printer Paper
Index Cards
Construction Paper
Construction Paper*Tru-Ray 9″ x 12″ Construction Paper, Salmon, 50 Sheets (P103010)
Copy & Printer Paper
Copy & Printer Paper
Copy & Printer Paper
Classroom Paper
Classroom Paper*Barker Creek Happy Bright Stripe Computer Paper, 100 Sheets/Set (BC3625)
Copy & Printer Paper
Copy Paper*EarthChoice 8.5″ x 14″ Copy Paper, 20 lbs., 92 Brightness, 500 Sheets/Ream (2702)
Reviews
There are no reviews yet.