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TOPS® UB-04 Forms, 1 Part, White, 8 1/2" x 11", Box Of 2,500 Item # 526935
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Used by hospitals and institutions to file a medical claim with a patient's insurance company
- Meets the requirements of the Centers for Medicare and Medicaid Services (CMS). Printed on carbonless, 20-lb bond, 1-ply paper with red ink.
|sheet size||Letter (8-1/2" x 11")|
|number of holes punched||0|
|number of parts||1|
|Product Line||UB-04 Forms|
|Eco Label Standard||SFI Certified Fiber Sourcing|
|manufacturer||TOPS BUSINESS FORMS|
|Product Type||Medical Claim Form|