TOPS UB-04 Continuous Forms 1 Part - 11" x 9.50" Form Size - White - Red Print Color - 2500 / Carton

UB-04 continuous forms are designed for hospitals to file a claim with the patient's insurance company. The Health Care Finance Administration format ensures accuracy in reporting all necessary information. Forms meet the requirements of the Centers for Medicare and Medicaid Services (CMS). Continuous forms are printed on 20 lb. bond paper.

Product Type - Claim Form Number Of Parts - 1 Form Length - 11 Form Width - 9.50 Environmentally Friendly - Yes Environmental Certification - SFI Printed Side - Front Country Of Origin - United States Recycled - No Manufacturer - TOPS Products Product Model - UB-04 Print Color - Red Manufacturer Part Number - 59770R Manufacturer Website Address - http://www.tops-products.com Green Indicator - Y