TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2″ X 11″, 2500/Carton (59770R
$124.89
The UB-04 is the form hospitals and institutions use to file a medical claim with the patient’s insurance company
- Revised Format
- AMA approved format
- Use TOPS UB-04 forms with confidence
- They meet the requirements of the Centers for Medicare and Medicaid Services (CMS) and are available in Laser and Continuous formats
- Made in the USA
| Attribute name | Attribute value |
|---|---|
| Length in Inches | 2500 |
| Number of Parts The physical dimensions of the form. | 8 1/2″ x 11″ |
| Width in Inches Items of a particular grouping, as merchandised and labeled by a manufacturer | UB04 Health Care Form |
| Medical Form Type Actual manufacturer name for the color of the product. | White |
| Print Type | Continuous |
Be the first to review “TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2″ X 11″, 2500/Carton (59770R”
Related products
Sale!
Original price was: $27.00.$20.99Current price is: $20.99.
Sale!
Original price was: $17.00.$12.89Current price is: $12.89.
Sale!
Original price was: $59.00.$41.89Current price is: $41.89.
Sale!
Original price was: $39.00.$29.89Current price is: $29.89.
Sale!
Original price was: $10.00.$7.99Current price is: $7.99.
Sale!
Original price was: $9.00.$6.99Current price is: $6.99.
Sale!
Notetaking
TOPS Jen Action Planner Subject Notebook, 6.73″ x 8.5″, Project Ruled, 100 Sheets, Black (TOP 63828)
Original price was: $14.00.$9.89Current price is: $9.89.
Reviews
There are no reviews yet.