TOPS Forms 59870R: UB04 Hospital Insurance Claim Form

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Forms, Record Keeping & Reference > Human Resources > Personnel Forms

Product Group: UB04 Hospital Insurance Claim Form [ view group ]

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TOP59870R

by TOPS Forms

Insurance / UB04 Hospital Claim Form, 8-1/2 x 11, 2500 Loose Forms / Carton

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TOP59870R

[ companion items ]

Insurance / UB04 Hospital Claim Form, 8-1/2 x 11, 2500 Loose Forms / Carton

Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format. Form Type: Insurance Claim; Format: Loose Form; Form Size (W x H): 8 1/2 in x 11 in; Sheet Size (W x H): 8 1/2 in x 11 in.

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Manufacturer	TOPS Forms [ view manufacturer ]
List Price	$172.88
Unit	CT
UPS Shippable	Yes
Recyclable	No
Shipping Weight	26 lbs
Catalog Page	904 [ all products on page 904 ]
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