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UB-04 Hospital Claim Form for Dot-Matrix Printers

UB-04 Hospital Claim Form for Dot-Matrix Printers

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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
  • Available in one, two, three and four-part forms
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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 Printershttp://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/s020080977.99USD/UB-04-Hospital-Claim-Form-for-Dot-Matrix-Printers/product_SS1034853 77.99USDEasily 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-Parthttp://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 81.69USDEasily 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-Parthttp://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 133.39USDEasily 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-Parthttp://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 88.49USDEasily 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-Parthttp://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
Price:
As low as
$77.99
2,500/Box

Currently Out of Stock.


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