TOPS 59770R UB-04 Continuous Forms
   
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TOPS 59770R UB-04 Continuous Forms

1 Part - 11" x 9.50" Form Size - White - Red Print Color - 2500 / Carton
Item #: TOP59770R

Retail/List price: $209.42
$129.39 for Carton
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Inventory last updated: 03/08/2021 11:10pm EST
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  • Description
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The Manufacturer's Description 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.

MAIN FEATURES

Product TypeClaim Form
Brand NameTOPS
ManufacturerTOPS Products
Product ModelUB-04
Product NameUB-04 Continuous Forms
Manufacturer Part Number59770R
Manufacturer Website Addresshttp://www.tops-products.com
Packaged Quantity2500 / Carton

OTHER FEATURES

Number of Parts1
Form Length11"
Form Width9.50"
Environmentally FriendlyYes
Environmental CertificationSFI
Number of Forms per Sheet1
Printed SideFront
Country of OriginUnited States
RecycledNo
Assembly RequiredNo
ColorWhite
Print ColorRed
Print TechnologyDot Matrix

ADDITIONAL CHARACTERISTICS

UPC code025932597701
Alternate code/substitutionTOP59770R
Moore prefix and stock number
Package Weight
Package Height
Package Length
Package Width
Product Classification CodeEFFA
Country of OriginUS
Ready to AssembleN
RecycledN
UPS-ableY
Recommended substitutions
Old item number
Minority/Women-Owned/Challenged Vendor
Old item number
Non-returnableN
Special order itemN
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