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TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - Red Print Color - 2500 / Carton

TOP59870R

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UB-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.

General Information
Manufacturer: TOPS Products
Manufacturer Part Number: 59870R
Manufacturer Website Address: http://www.tops-products.com
Product Model: UB-04
Product Name: 1-part UB-04 Laser-cut Forms
Packaged Quantity: 2500 / Carton

Product Information
Number of Forms per Sheet: 1
Form Length: 11"
Form Width: 8.50"
Number of Parts: 1
Printed Side: Front
Print Color: Red
Print Technology: Laser

Physical Characteristics
Color: White

Miscellaneous
Certifications & Standards:

American Medical Association


Environmentally Friendly: Yes
Environmental Certification: SFI

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in Filesystem.php line 122
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at file_put_contents('/var/www/html/storage/framework/sessions/Y8hK7brOJe6GsxiOLpbdBYJmHWRixPBisdXZHwqE', 'a:3:{s:6:"_token";s:40:"Twu4bh35FSvk6rtXVfsWUVPJWppkwdmn39Ex1rvS";s:9:"_previous";a:1:{s:3:"url";s:36:"https://usbpi.com/product/1014265164";}s:6:"_flash";a:2:{s:3:"old";a:0:{}s:3:"new";a:0:{}}}', 2)in Filesystem.php line 122
at Filesystem->put('/var/www/html/storage/framework/sessions/Y8hK7brOJe6GsxiOLpbdBYJmHWRixPBisdXZHwqE', 'a:3:{s:6:"_token";s:40:"Twu4bh35FSvk6rtXVfsWUVPJWppkwdmn39Ex1rvS";s:9:"_previous";a:1:{s:3:"url";s:36:"https://usbpi.com/product/1014265164";}s:6:"_flash";a:2:{s:3:"old";a:0:{}s:3:"new";a:0:{}}}', true)in FileSessionHandler.php line 83
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at Store->save()in StartSession.php line 88
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at Kernel->terminateMiddleware(object(Request), object(Response))in Kernel.php line 189
at Kernel->terminate(object(Request), object(Response))in index.php line 58