Home / Office Supplies / Office / Forms, Recordkeeping & Reference Materials / UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 FormsTOP-59870R
Picture of UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 FormsTOP-59870R

UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 FormsTOP-59870R

UB04-Hospital-Insurance-Claim-Form,-8-1-2-x-11,-Laser-Printer,-2500-FormsTOP-59870R

SKU #

#628058

MPN #

TOP-59870R

Brand

TOPS™

Stock

In Stock

Quantity

100

Features

FORM,UB-04,1-PT,LASER,WE

$208.48 USD

Product Specifications Product Usage Additional Information
Print
Attribute Name Attribute Value
McKesson # 628058
Manufacturer # TOP-59870R
Manufacturer TOPS™
Form Quantity 2500
Form Size 8.5 x 11
Forms Per Page 1
Global Product Type Forms-Insurance
Layout One Form per Sheet
Paper Color(s) White
Paper Stock 20-lb.
Post-Consumer Recycled Content Percent 0%
Pre-Consumer Recycled Content Percent 0%
Print and Ruling Color(s) Red
Printer Compatibility Laser
Special Features For Laser Printers
Total Recycled Content Percent 0%
UNSPSC 14111806
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  • Printed to Government Printing Office standards.
  • OCR ink for scanning.
  • American Medical Association (AMA) approved format.