• TOPS 1-part UB-04 Laser-cut Forms
    TOPS 1-part UB-04 Laser-cut Forms
1 1

TOPS 1-part UB-04 Laser-cut Forms

TOPS 1-part UB-04 Laser-cut Forms

SKU: 1014265164      MFR: TOPS Products

Product Description

TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton

Manufacturer : TOPS Products

Manufacturer Part No : 59870R

Features

  • 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

Product Details

Product TypeClaim Form
Number of Parts1
Form Length11"
Form Width8.50"
Country of OriginUnited States
RecycledNo
Brand NameTOPS
Print ColorRed
Environmentally FriendlyYes
Environmental CertificationSFI
Printed SideFront
ManufacturerTOPS Products
Product ModelUB-04
Product Name1-part UB-04 Laser-cut Forms
Manufacturer Part Number59870R
Manufacturer Website Addresshttp://www.tops-products.com
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 Quantity2500 / Carton
Number of Forms per Sheet1
Assembly RequiredNo
ColorWhite
Certifications & Standards

American Medical Association
Print TechnologyLaser
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$333.99 USD
$333.99
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TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton

Manufacturer : TOPS Products

Manufacturer Part No : 59870R

Features

  • 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

Product Details

Product TypeClaim Form
Number of Parts1
Form Length11"
Form Width8.50"
Country of OriginUnited States
RecycledNo
Brand NameTOPS
Print ColorRed
Environmentally FriendlyYes
Environmental CertificationSFI
Printed SideFront
ManufacturerTOPS Products
Product ModelUB-04
Product Name1-part UB-04 Laser-cut Forms
Manufacturer Part Number59870R
Manufacturer Website Addresshttp://www.tops-products.com
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 Quantity2500 / Carton
Number of Forms per Sheet1
Assembly RequiredNo
ColorWhite
Certifications & Standards

American Medical Association
Print TechnologyLaser

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