UB04-One Part Continuous, Removable Margins, 2500 EA/CT
$209.42
TOPS
Must be purchased in multiples of 1 carton
TOP 59770R
The UB-04 is the form hospitals and institutions use to file a medical claim with the patient's insurance company. Use TOPS UB-04 forms with confidence. They meet the requirements of the Centers for Medicare and Medicaid Services (CMS). 1 part continuous.
Available in increments of 1
- UB-04 1-part continuous is a form that hospitals use 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
- Printed on 20 lb. bond paper
- 9-1/2" x 11"
- Replaces UB-92
- Made in the USA
| Item # | TOP 59770R |
|---|---|
| Length | 9.5 |
| Width | 11 |
| Color | White |
| Templates Available | N |
| Load Style | N/A |
| Demo Address | N/A |
| Paper Weight | 20 lb. |
| Acid Free | N/A |
| Dimensions | N/A |
| Cover | No |
| Sheet Count | N/A |
| Backing | N/A |
| Perforated | N/A |
| Perforation Type | NA |
| Primary Page Coloring | White |
| Number of Sheets per Pad | N/A |
| Number of Sheets per Pack | N/A |
| Pages Numbered | No |
| Pages Consecutively Numbered | No |
| Hole Punched | No |
| Printed Front and Back | Yes |
| Form Type | Medical |
| Number of Columns | N/A |
| Forms Per Page | 1 |
| Number of Entry Lines | N/A |
| Form Quantity | 2500 |
| Sections | N/A |
| Duplicate Page Coloring | N/A |
| Triplicate Page Coloring | N/A |
| Detached Form Size | 11 x 8.5 |
| Sheet Size | 11 x 9.5 |
| Form Duplicate | Carbon |
| Number of Forms Per Page | 1 |
| Ink Color on Form | Red |
| Hole Punch Location | N/A |
| Compatibility - Describe | Continuous feed printers |
| CD Included | No |
| Wrap-around Cover | No |
| Stub | No |
| Time Clock Compatibility | N/A |
| Self-Seal | No |
| Time Increments | N/A |
| Corner and Spine Color | N/A |
| Cover Texture | N/A |
| Cover Interior Printing | N/A |
| Book Size | N/A |
| Format | N/A |
| Ribbon Bookmark | N/A |
| Purchasing Quantity | Must be purchased in multiples of 1 carton |
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