Sub total:
$138.00
total:
$138.00
TOPS UB-04 Continuous Forms
TOPS UB-04 Continuous Forms - 1 Part - 11 x 9.50 Form Size - Red Print Color - 2500 / Carton
Currently out of stock
Item: 59770R | By: TOPS
$201.36EA
Condition
New
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Product description
UB-04 continuous forms are designed for hospitals 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). Continuous forms are printed on 20 lb. bond paper.
Specifications
Brand Name
TOPS
Color
White
Country of origin
United States
Environmental Certification
SFI
Environmentally Friendly
Yes
Form Length
11"
Form Width
9.50"
Manufacturer Part Number
59770R
Manufacturer Website Address
http://www.tops-products.com
Number of Parts
1
Packaged Quantity
2500 / Carton
Print Color
Red
Print technology
Dot Matrix
Printed Side
Front
Product Model
UB-04
Product Name
UB-04 Continuous Forms
Manufacturer
TOPS Products
Product Type
Claim Form
Recycled
No