Home > Office Supplies > General Supplies > Forms, Recordkeeping & Reference Materials > Forms & Recordkeeping Systems > Medical/Insurance Forms >

TOPS Insurance/UB04 Hospital Claim Form, 8-1/2 x 11, 2500 Loose Forms/Carton # TOP59870R
TOPS Insurance/UB04 Hospital Claim Form, 8-1/2 x 11, 25
 
Sale Price: $212.02
Estimated Shipping Cost: $15.89

Availability: Typically Arrives Next Business Day
Product Code: TOP-59870R
Quantity:

Description
 
UB04 hospital insurance claim form.
 
Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format. Form Size (W x H): 8 1/2 in x 11 in; Number of Columns: N/A; Forms Per Page: N/A; Number of Entry Lines: N/A.
Features
  • Printed to Government Printing Office standards.
  • OCR ink for scanning.
  • American Medical Association (AMA) approved format.
  • Manufacturer's limited lifetime warranty.

Other People Purchased
Boardwalk Bath Tissue, Two-Ply, 500 Sheets/Roll, White, 96 Rolls/Case # BWK6180 Dixie Hot Cups, Paper, 8 oz., Coffee Dreams Design, 500/Carton # DXE5338DX Universal File Folders, 1/3 Cut Assorted, One-Ply Top Tab, Letter, Manila, 100/Bx. UNV12113
Sale Price: $85.60

Add
Sale Price: $60.10

Add
Sale Price: $13.25

Add
Boardwalk® Bath Tissue, Two-Ply, 500 Sheets/Roll, White, 96 Rolls/Case # BWK6180 Dixie Hot Cups, Paper, 8 oz., Coffee Dreams Design, 500 Universal File Folders, 1/3 Cut Assorted, One-Ply Top T

Share your knowledge of this product with other customers... Be the first to write a review or ask a question