$343.14
1 Part – 11″ x 8.50″ Form Size – White – Red Print Color – 2500 / Carton
| Categories | Claim/Medical Forms, Forms & Recordkeeping |
|---|---|
| Weight | 26 lbs |
| Dimensions | 11.5 × 11 × 8.5 in |
| Manufacturer | |
| Brand Name | TOPS |
| Product Type | Claim Form |
| Product Color | White |
| Country of Origin | United States |
| Color Family | White |
| Manufacturer | TOPS Products |
| Manufacturer Part Number | 59870R |
| Manufacturer Website Address | http://www.tops-products.com |
| Brand Name | TOPS |
| Product Model | UB-04 |
| Product Name | 1-part UB-04 Laser-cut Forms |
| Marketing Information | 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 |
| Color Family | White |
| Product Color | White |
| Certifications & Standards | American Medical Association |
| Recycled | No |
| Assembly Required | No |
| Country of Origin | United States |
| Environmental Certification | Sustainable Forestry Initiative (SFI) |
