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Tops - 59870R - UB04 Hospital Insurance Claim Form, 8 1/2 x 11, 2, 500 Forms

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Product Overview

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.


Manufacturer Tops
Mfg Part# 59870R
SKU 211344266
UPC 025932598708
UPC 14 00025932598708
Product Type Claim Form
Manufacturer Part Number 59870R
Manufacturer TOPS Products
Product Model UB-04
Product Name UB-04 Hospital Claim Form
Brand Name TOPS
Country of Origin United States
Recycled No
Environmentally Friendly Yes
Environmental Certification SFI
Print Color Red
Number of Parts 1
Form Length 11"
Form Width 8.50"
Printed Side Front

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BisonOffice $112.30 + free shipping
Condition: Brand New
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Includes 500 forms.
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BeachAudio $100.18 + $12.65 shipping
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