Outlet UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2″ X 11″, 2500/Carton (59770R Medical Forms
$132.89
The UB-04 is the form hospitals and institutions use to file a medical claim with the patient’s insurance company
- Revised Format
- AMA approved format
- Use TOPS UB-04 forms with confidence
- They meet the requirements of the Centers for Medicare and Medicaid Services (CMS) and are available in Laser and Continuous formats
- Made in the USA
| Attribute name | Attribute value |
|---|---|
| Length in Inches | 2500 |
| Number of Parts The physical dimensions of the form. | 8 1/2″ x 11″ |
| Width in Inches Items of a particular grouping, as merchandised and labeled by a manufacturer | UB04 Health Care Form |
| Medical Form Type Actual manufacturer name for the color of the product. | White |
| Print Type | Continuous |
Be the first to review “Outlet UB04 Health Care Form, Revised, HCFA Compliant, 8 1/2″ X 11″, 2500/Carton (59770R Medical Forms”
Related products
$6.89
Sale!
Original price was: $39.00.$27.89Current price is: $27.89.
Sale!
Original price was: $10.00.$7.99Current price is: $7.99.
Sale!
Notebooks
TOPS Royale Professional Notebooks, 5.88″ x 8.25″, College Ruled, 96 Sheets, Black (25330) Discount
Original price was: $19.00.$14.99Current price is: $14.99.
Sale!
Notetaking
TOPS Jen Action Planner Subject Notebook, 6.73″ x 8.5″, Project Ruled, 100 Sheets, Black (TOP 63828)
Original price was: $14.00.$10.89Current price is: $10.89.
Sale!
Original price was: $21.00.$15.89Current price is: $15.89.
Sale!
Original price was: $58.00.$42.89Current price is: $42.89.
Sale!
Notetaking
TOPS 1-Subject Notebook, 8″ x 10.5″, College Ruled, 70 Sheets, Assorted Colors (TOP 65021) Outlet
Original price was: $3.00.$2.89Current price is: $2.89.
Sale!
Original price was: $16.00.$11.89Current price is: $11.89.
Sale!
Original price was: $26.00.$18.89Current price is: $18.89.
Reviews
There are no reviews yet.