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UB04 Hospital Insurance Claim Form, 8 1/2 x 11, 2,500 Forms

Manufacturer: TOPS®

Item Number: TOP59870R

  • Printed to Government Printing Office standards.
  • OCR ink for scanning.
  • American Medical Association (AMA) approved format.

$155.59

per CT

  • Made in the USA
    • Made in the USA
Details

Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format. Form Size: 8 1/2 x 11; Forms Per Page: 1.

Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format. Form Size: 8 1/2 x 11; Forms Per Page: 1.

Paper Color(s) Red, White 
Global Product Type Forms-Insurance Claim 
Layout One Form per Sheet 
Print and Ruling Color(s) Red 
Paper Stock 20-lb. 
Printer Compatibility Laser 
Special Features For Laser Printers 
Pre-Consumer Recycled Content Percent 0% 
Post-Consumer Recycled Content Percent 0% 
Total Recycled Content Percent 0% 
Form Quantity 2500 
Form Size 8 1/2 x 11 
Forms Per Page
Reviewer Product Comments