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TOPS Insurance/UB04 Hospital Claim Form, 8-1/2 x 11, 2500 Loose Forms/Carton # TOP59870R
Estimated Shipping Cost:
Typically Arrives Next Business Day
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.
Printed to Government Printing Office standards.
OCR ink for scanning.
American Medical Association (AMA) approved format.
Manufacturer's limited lifetime warranty.
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