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TOPS UB-04 Continuous Hospital Insurance Claim Form, 1 Part, 9.5 x 11 Inches, Removable Margins, 2500 Sheets per Carton, White (59770R)

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Product Information

UB-04 1-part continuous is a form that hospitals use to file a claim with the patient's insurance company
Forms are printed to GPO standards in OCR ink on 20 lb. bond
9.5 x 11 inch size - 2,500 sheets per carton
Replaces UB-92
Meets the requirements of the Centers for Medicare and Medicaid Services (CMS)

Attributes

Part Number

59770R

Label

TOPS Business Forms, Inc.

Number Of Items

Publication Date

2011-04-01

Publisher

TOPS Business Forms, Inc.

Studio

TOPS Business Forms, Inc.

Lang

en-US

Product Identifiers

AID

AIDFHQ732001

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ASIN

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EAN

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UPC

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Shipping Dimensions

Width

11.1 in.

Length

12.9 in.

Height

10.4 in.

Weight

460.8 oz.

Product Dimensions

Width

11 in.

Length

9.5 in.

Weight

448 oz.

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