Tops - TOP59870R - UB04 Hospital Insurance Claim Form
Product Description
Tops - TOP59870R - UB04 Hospital Insurance Claim Form
- 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
Technical Specifications
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