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Tops UB-04 Hospital Claim Form - 2500 / Carton
General Info:
- Quantity : 2500 / Carton
- Brand Name: Tops
- Manufacturer Part Number: 59770R
- Form Size: 11" Length x 8.50" Width
- Number of Parts: 1 Part
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UB-04 continuous forms are designed for hospitals to file a claim with the patients 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.
Technical Specifications:
Miscellaneous
Recycled: No
Recycled Content: 0%
Post-consumer-waste%: 0%
Assembly Required: No
Recycled Content: 0%
Post-consumer-waste%: 0%
Assembly Required: No
Product Information
Media Quantity: (1 Form Per Sheet)
Form Size: 11" Length x 8.50" Width
Number of Parts: 1 Part
Print: Front Side Form With Red Ink
Print Technology: Dot Matrix
Color: White
Form Size: 11" Length x 8.50" Width
Number of Parts: 1 Part
Print: Front Side Form With Red Ink
Print Technology: Dot Matrix
Color: White
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