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Tops Ub-04 Hospital Claim Form - 1 Part - 11" X 8.50" Form Size - 2500... 

Over 50 in stock (as of 12/07/2016 07:02 AM)

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Tops Ub-04 Hospital Claim Form - 1 Part - 11" X 8.50" Form Size - 2500 / Carton (59870R)
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Added to our catalog within last 30 days
Model: 59870R
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$123.26
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Description

Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format. Form Size: 8 1/2 x 11; Forms Per Page: 1; Form Quantity: 2500; Layout: One Form per Sheet.
  • Printed to Government Printing Office standards.
  • OCR ink for scanning.
  • American Medical Association (AMA) approved format.
  • Features

    Certifications & Standards: 

    American Medical Association



    Recycled: No

    Recycled Content: 0%

    Post-consumer-waste%: 0%

    Assembly Required: No

    Environmentally Friendly: Yes

    Environmental Certification: SFI

    Country of Origin: United States

    Specification

    General Information
    ManufacturerTOPS Products
    Manufacturer Part Number59870R
    Manufacturer Website Addresshttp://www.tops-products.com
    Brand NameTOPS
    Product ModelUB-04
    Product NameUB-04 Hospital Claim Form
    Marketing Information

    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.

    Packaged Quantity2500 / Carton
    Product TypeClaim Form
    Product Information
    Number of Forms per Sheet1
    Form Length11"
    Form Width8.50"
    Number of Parts1
    Printed SideFront
    Print ColorRed
    Print TechnologyLaser
    Physical Characteristics
    ColorWhite
    Title
    ProductTitleTOPS UB-04 Hospital Claim Form - 1 Part - 11" x 8.50" Form Size - Red Print Color - 2500 / Carton

    Warranty Information

    Beach Audio Warranty

    This product was added to our catalog on Wednesday, December 07, 2016.

    Code:35-59870r

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