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UB-04 Hospital Claim Form for Dot-Matrix Printers, 2-Part
UB-04 Hospital Claim Form for Dot-Matrix Printers, 2-Part

UB-04 Hospital Claim Form for Dot-Matrix Printers, 2-Part

Price:
$62.99
1,000/Box

Currently Out of Stock.

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  • Item: 683687
  • Model: UB042
57.99Easily file a medical claim with a patient's insurance carrierFile a hard copy of each claim with patient records in case you need to resubmit a claimAvailable in one, two, three and four-part formsUB-04 Hospital Claim Form for Dot-Matrix Printershttp://s7d5.scene7.com/is/image/Staples/s0200809_sc7?$std$http://s7d5.scene7.com/is/image/Staples/s0200809_sc7?$thb$http://s7d5.scene7.com/is/image/Staples/s0200809/UB-04-Hospital-Claim-Form-for-Dot-Matrix-Printers/product_SS1034853UB-04 Hospital Claim Form for Dot-Matrix Printers0.00 57.99Easily file a medical claim with a patient's insurance carrierFile a hard copy of each claim with patient records in case you need to resubmit a claim1-Part formsUB-04 Hospital Claim Form for Dot-Matrix Printers, 1-Parthttp://s7d5.scene7.com/is/image/Staples/s0200809_sc7?$std$http://s7d5.scene7.com/is/image/Staples/s0200809_sc7?$thb$http://s7d5.scene7.com/is/image/Staples/s0200809/UB-04-Hospital-Claim-Form-for-Dot-Matrix-Printers-1-Part/product_683688UB-04 Hospital Claim Form for Dot-Matrix Printers, 1-Part0.00 62.99Easily file a medical claim with a patient's insurance carrierFile a hard copy of each claim with patient records in case you need to resubmit a claim2-Part formsUB-04 Hospital Claim Form for Dot-Matrix Printers, 2-Parthttp://s7d5.scene7.com/is/image/Staples/s0200809_sc7?$std$http://s7d5.scene7.com/is/image/Staples/s0200809_sc7?$thb$http://s7d5.scene7.com/is/image/Staples/s0200809/UB-04-Hospital-Claim-Form-for-Dot-Matrix-Printers-2-Part/product_683687UB-04 Hospital Claim Form for Dot-Matrix Printers, 2-Part0.00 109.99Easily file a medical claim with a patient's insurance carrierFile a hard copy of each claim with patient records in case you need to resubmit a claim3-Part formsUB-04 Hospital Claim Form for Dot-Matrix Printers, 3-Parthttp://s7d5.scene7.com/is/image/Staples/s0200809_sc7?$std$http://s7d5.scene7.com/is/image/Staples/s0200809_sc7?$thb$http://s7d5.scene7.com/is/image/Staples/s0200809/UB-04-Hospital-Claim-Form-for-Dot-Matrix-Printers-3-Part/product_683686UB-04 Hospital Claim Form for Dot-Matrix Printers, 3-Part0.00 72.99Easily file a medical claim with a patient's insurance carrierFile a hard copy of each claim with patient records in case you need to resubmit a claim4-Part formsUB-04 Hospital Claim Form for Dot-Matrix Printers, 4-Parthttp://s7d5.scene7.com/is/image/Staples/s0200809_sc7?$std$http://s7d5.scene7.com/is/image/Staples/s0200809_sc7?$thb$http://s7d5.scene7.com/is/image/Staples/s0200809/UB-04-Hospital-Claim-Form-for-Dot-Matrix-Printers-4-Part/product_683685UB-04 Hospital Claim Form for Dot-Matrix Printers, 4-Part0.00

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  • Easily file a medical claim with a patient's insurance carrier
  • File a hard copy of each claim with patient records in case you need to resubmit a claim
  • 2-Part forms
  • Continuous forms, compatible with Dot-Matrix printers
Parts Yes
Quantity 1,000/Box
Model # UB042
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UB-92/UB-04 Hospital Claim Envelopes, 9in. x 12-1/2in.
Item 519753
Model 1492LL
 UB-92/UB-04 Hospital Claim Envelopes, 9" x 12-1/2"
  • UB-92 matching jumbo envelopes
  • 9" x 12-1/2"
  • Compatible with Laser and Dot-Matrix printers
 Expected Delivery7 - 14 Business Days
Price:
$28.49
100/Box
 Qty. Add to Favorites
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UB-04 Hospital Claim Form for Dot-Matrix Printers, 3-Part

UB-04 Hospital Claim Form for Dot-Matrix Printers, 3-Part

Price:$109.991,000/Box
Qty. Add to Cart
Add to Favorites
  • Item qualifies for free delivery
  • Expected Delivery 7-14 Business Days
  • Item qualifies for free delivery to a store near you. (Learn more)
  • Delivery Only
  • Item: 683686
  • Model: UB043

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