- Continuous forms are designed for hospitals to file a claim with the patient's insurance company
- Forms are printed to GPO standards in OCR ink on 20 lb. bond
- Health Care Finance Administration format ensures accuracy in reporting all necessary information
- 11" Length x 8.50" Width; 2500 / Carton
- Replaces the UB-92
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TOPS 1-part UB-04 Laser-cut Forms
1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton
Product Code: TOP59870R
5 Stock Available
Product Details
General Information
| Manufacturer | TOPS Products |
| Manufacturer Part Number | 59870R |
| Manufacturer Website Address | http://www.tops-products.com |
| Brand Name | TOPS |
| Product Model | UB-04 |
| Product Name | 1-part UB-04 Laser-cut Forms |
| 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 Quantity | 2500 / Carton |
| Product Type | Claim Form |
Product Information
| Number of Forms per Sheet | 1 |
| Form Length | 11" |
| Form Width | 8.50" |
| Number of Parts | 1 |
| Printed Side | Front |
| Print Color | Red |
| Print Technology | Laser |
Physical Characteristics
| Product Color | White |
Miscellaneous
| Certifications & Standards |
American Medical Association |
| Recycled | No |
| Assembly Required | No |
| Environmental Certification | Sustainable Forestry Initiative (SFI) |
| Country of Origin | United States |
Description
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