TOPS™ UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total
Our Price: $388.75 CT
Available on backorder
Description
TOPS™ UB04 Hospital Insurance Claim Form
Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format.
Features:
Printed to Government Printing Office standards.
OCR ink for scanning.
American Medical Association (AMA) approved format.
**SPECIAL ORDER ITEM Please allow 7-14 days for delivery**
Keywords: Claim Form; Claim Forms; Continuous Form; HCFA Claim Form; Health Care Claim Forms; Human Resources; Insurance Forms; Personnel; Personnel Forms; TOPS; UB04; Paperwork; Records; Documents; Pre-Printed; Record-Keeping
Additional information
| Weight | 10.250 lbs |
|---|---|
| Dimensions | 12.000 × 9.250 × 12.000 in |
| Brand | |
| Manufacturer Part Number |
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