TOPS UB04 Hospital Insurance Claim Form, 8 1/2 x 11, Laser Printer, 2500 Forms
Part # TOP59870R
UPC 025932598708
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Product Details
TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton
- Part #: TOP59870R
- MPN: TOP 59870R
- UNSPSC:
1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton
General Information
Manufacturer:TOPS Products
Manufacturer Part Number:59870R
Manufacturer Website Address:http://www.tops-products.com
Brand Name:TOPS
Product Model:UB-04
Product Name:1-part UB-04 Laser-cut Forms
Marketing Information:
Packaged Quantity:2500 / Carton
Product Type:Claim Form
Manufacturer:TOPS Products
Manufacturer Part Number:59870R
Manufacturer Website Address:http://www.tops-products.com
Brand Name:TOPS
Product Model:UB-04
Product Name:1-part UB-04 Laser-cut Forms
Marketing Information:
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.
Packaged Quantity:2500 / Carton
Product Type:Claim Form
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
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
Color:White
Miscellaneous
Certifications & Standards:
Recycled:No
Assembly Required:No
Environmentally Friendly:Yes
Environmental Certification:SFI
Country of Origin:United States
Certifications & Standards:
American Medical Association
Recycled:No
Assembly Required:No
Environmentally Friendly:Yes
Environmental Certification:SFI
Country of Origin:United States
- 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.
| Brand | TOPS |
|---|---|
| Form Size | 8.5 x 11 |
| Forms Per Page | 1 |
| Form Quantity | 2500 |
| Layout | One Form per Sheet |
| Printer Compatibility | Laser |
| Paper Stock | 20-lb. |
| Paper Color(s) | Red; White |
| Print and Ruling Color(s) | Red |
| Pre-Consumer Recycled Content Percent | 0% |
| Post-Consumer Recycled Content Percent | 0% |
| Total Recycled Content Percent | 0% |
| Special Features | For Laser Printers |
| Country of Origin | US |
| Prop65 | No |
| Unit of Measure | CT |
| Last Updated | 8/11/2020 |
Additional Information
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