$333.15
CT
TOP59870R
TOPS 1-part UB-04 Laser-cut Forms
1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton
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  • 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" Length x 8.50" Width; 2500 / Carton
  • Replaces the UB-92
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