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SPI TOPS 1 part UB 04 Laser cut Forms P8030629SPI-TOP59870R https://cdnimages.opentip.com/full/SPI/SPI-TOP59870R.jpg TOPS 1 part UB 04 Laser cut Forms 1 Part - 11\" x 8.50\" Form Size - White - Red Print Color - 2500 / CartonContinuous forms are designed for hospitals to file a claim with the patient\'s insurance companyForms are printed to GPO standards in OCR ink on 20 lb. bondHealth Care Finance Administration format ensures accuracy in reporting all necessary information11\\Details: General InformationManufacturerTOPS ProductsManufacturer Part Number59870RBrand NameTOPSProduct ModelUB-04Product Name1-part UB-04 Laser-cut FormsMarketing InformationUB-04 laser-cut forms are designed for medical offices 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). Forms are printed on 20 lb. bond paper.Packaged Quantity2500 / CartonProduct TypeClaim FormProduct InformationNumber of Forms per Sheet1Form Length11\"Form Width8.50\"Number of Parts1Printed SideFrontPrint ColorRedPrint TechnologyLaserPhysical CharacteristicsProduct ColorWhiteMiscellaneousCertifications & StandardsAmerican Medical AssociationRecycledNoAssembly RequiredNoEnvironmental CertificationSFICountry of OriginUnited StatesCatalog Page Number588Packing, Level 11 / EAPacking, Level 22500 EA/CTWeight26 lbsUPSableUPC025932598708UNSPSC14111804Special OrderNoColorWHITE/REDQuantity Per Selling Unit2500/CTReturnable 8030629 025932598708 31.2000lbs 11.00 8.50 11.50
TOPS
217.2100 2025-07-07 83 In Stock

TOPS 1-part UB-04 Laser-cut Forms, Price/CT

Brand TOPS
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UPC: 025932598708
SKU: SPI-TOP59870R
Price: $217.21
Quantity:
Shipping:
$19.89 To [ 43215 ] Estimated Delivery Date: Jul 10, 2024 to Jul 12, 2024
83 In Stock
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Product Description

Price is for CT.

1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton
  • Continuous forms are designed for hospitals to file a claim with the patient's insurance company
  • Forms are printed to GPO standards in OCR ink on 20 lb. bond
  • Health Care Finance Administration format ensures accuracy in reporting all necessary information
  • 11


  • Details: General Information

    Product Information

    Physical Characteristics

    Miscellaneous

    warning tips WARNING: This product can expose you to chemicals which are known to the State of California to cause cancer, birth defects, or other reproductive harm. For more information, go to www.p65warnings.ca.gov.
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