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

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

Item: 683685    Model: UB044

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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
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  • FREE SHIPPING, Plus up to 5% back for Rewards Members
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Easily 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 formsSelect an ItemEasily 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 Printers70.99USDhttp://www.staples-3p.com/s7/is/image/Staples/s0200809_sc7?$std$http://www.staples-3p.com/s7/is/image/Staples/s0200809_sc7?$thb$http://www.staples-3p.com/s7/is/image/Staples/s0200809/UB-04-Hospital-Claim-Form-for-Dot-Matrix-Printers/product_SS1034853 Easily 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 forms2,500/Box1-PartEasily 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-Part77.99USDhttp://www.staples-3p.com/s7/is/image/Staples/s0200809_sc7?$std$http://www.staples-3p.com/s7/is/image/Staples/s0200809_sc7?$thb$http://www.staples-3p.com/s7/is/image/Staples/s0200809/UB-04-Hospital-Claim-Form-for-Dot-Matrix-Printers-1-Part/product_683688 Easily 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 forms1,000/Box2-PartEasily 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-Part70.99USDhttp://www.staples-3p.com/s7/is/image/Staples/s0200809_sc7?$std$http://www.staples-3p.com/s7/is/image/Staples/s0200809_sc7?$thb$http://www.staples-3p.com/s7/is/image/Staples/s0200809/UB-04-Hospital-Claim-Form-for-Dot-Matrix-Printers-2-Part/product_683687 Easily 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 forms1,000/Box3-partEasily 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-Part133.39USDhttp://www.staples-3p.com/s7/is/image/Staples/s0200809_sc7?$std$http://www.staples-3p.com/s7/is/image/Staples/s0200809_sc7?$thb$http://www.staples-3p.com/s7/is/image/Staples/s0200809/UB-04-Hospital-Claim-Form-for-Dot-Matrix-Printers-3-Part/product_683686 Easily 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 forms500/Box4-PartEasily 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-Part76.99USDhttp://www.staples-3p.com/s7/is/image/Staples/s0200809_sc7?$std$http://www.staples-3p.com/s7/is/image/Staples/s0200809_sc7?$thb$http://www.staples-3p.com/s7/is/image/Staples/s0200809/UB-04-Hospital-Claim-Form-for-Dot-Matrix-Printers-4-Part/product_683685

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