TOPS® UB-04 Forms, 1 Part, White, 8 1/2″ x 11″, Box Of 2,500
$124.99
Used by hospitals and institutions to file a medical claim with a patient’s insurance company
- Meets the requirements of the Centers for Medicare and Medicaid Services (CMS). Printed on carbonless, 20-lb bond, 1-ply paper with red ink.
Product Specifications
| Item # | 526935 |
| Manufacturer # | 59870R |
| Color (Ink) | Red |
| sheet size | Letter (8-1/2″ x 11″) |
| number of holes punched | 0 |
| double sided | Yes |
| number of parts | 1 |
| carbonless | Yes |
| Product Line | UB-04 Forms |
| quantity | 2500 |
| brand name | TOPS |
| Eco Label Standard | SFI Certified Fiber Sourcing |
| manufacturer | TOPS BUSINESS FORMS |
| Total Quantity | 2500 Medical Claim Forms |
| UPC | 025932598708 |
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