1 Part – 11″ x 8.50″ Form Size – White – Red Print Color – 2500 / Carton
TOPS 1-part UB-04 Laser-cut Forms – 1 Part – 11″ x 8.50″ Form Size – White – Red Print Color – 2500 / Carton
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| Brand Name | TOPS |
|---|---|
| Country of Origin | United States |
| Environmental Certification | SFI |
| Form Length | 11" |
| Form Width | 8.50" |
| Manufacturer | TOPS Products |
| Manufacturer Part Number | 59870R |
| Manufacturer Website Address | |
| 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. |
| Number of Parts | 1 |
| Packaged Quantity | 2500 / Carton |
| Print Color | Red |
| Printed Side | Front |
| Product Model | UB-04 |
| Product Name | 1-part UB-04 Laser-cut Forms |
| Product Type | Claim Form |
| Recycled | No |
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