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- Revised Format
- AMA approved format
- Use TOPS UB-04 forms with confidence
MADE IN AMERICA
TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2" X 11", 2500/Carton (59770R
Item #: 890389Model #: 59770R
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Attributes | TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2" X 11", 2500/Carton (59770R | ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Pack of 250 (CMS12LC250) | ComplyRight CMS-1500 Health Insurance Claims, 2500/Pack (CMS12LC) | TOPS Centers for Medicare and Medicaid Services Forms, 8-1/2" x 11" (50135RV) | ComplyRight CMS-1500 Health Insurance Claim Forms (02/12), 8-1/2" x 11", Box of 1,000 (CMS12LC1) |
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Your product TOPS UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2" X 11", 2500/Carton (59770R Price is $195.39 Out of Stock | |||||
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Delivery Information | Data not available | Delivery by Mon, Jun 16 | Free delivery by Mon, Jun 16 | Delivery by Mon, Jun 09 | Free delivery by Mon, Jun 09 |
Available in my store | No | No | No | No | No |
Length in Inches | 11 | 11 | 11 | 11 | 11 |
Medical Form Pack Size | 2500 | 250 | 2500 | 250 | 1000 |
Width in Inches | 8.5 | 8.5 | 8.5 | 8.5 | 8.5 |
Medical Form Type | Health Insurance Claims | Health Insurance Claims | Health Insurance Claims | Consent | Health Insurance Claims |
True Color | White | White / Red | White / Red | Red and White | White / Red |
Print Type | Continuous | Laser | Laser | Continuous | Laser |
Number of Parts | 1 | 1 | 1 | 1 | 1 |
Form Size | 8 1 / 2" x 11" | Data not available | 8 1 / 2" x 11" | 8 1 / 2" x 11" | Data not available |
Series or Collection | UB04 Health Care Form | Data not available | CMS-1500 | Centers for Medicare and Medicaid Services | Data not available |
Add To Cart | Add To Cart | Add To Cart | Add To Cart |