UB-04 Hospital Claim Form for Dot-Matrix Printers, 4-Part

Price:: $72.99; 500/Box

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Item: 683685
Model: UB044

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
4-Part forms
Continuous forms, compatible with Dot-Matrix printers

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