TOPS 1-part UB-04 Laser-cut Forms
Stock #TOP59870R
$329.40
/ 2500 / Carton
- 1 + $329.40 CT
1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton
- 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
| Specs: | Detailed Description: |
|---|---|
| Manufacturer | TOPS Products |
| Manufacturer Part Number | 59870R |
| Brand Name | TOPS |
| Product Model | UB-04 |
| Product Name | 1-part UB-04 Laser-cut Forms |
| Product Description |
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 |
| 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 |
| Product Color | White |
| Certifications & Standards |
American Medical Association |
| Recycled | No |
| Assembly Required | No |
| Country of Origin | United States |
| Environmental Certification | Sustainable Forestry Initiative (SFI) |
Significant Savings
Please call our Customer Care Center at 800.222.0510 or contact us to learn how volume purchase plans can result in significant savings for your firm. If you choose to purchase a quantity greater than shown, discounted pricing will be applied after this order is submitted and will be reflected on your invoice.
Please call our Customer Care Center at 800.222.0510 or contact us to learn how volume purchase plans can result in significant savings for your firm. If you choose to purchase a quantity greater than shown, discounted pricing will be applied after this order is submitted and will be reflected on your invoice.