Product TOP59870R TOPS 1-part UB-04 Laser-cut Forms

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TOP59870R

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TOPS Products

TOPS 1-part UB-04 Laser-cut Forms

1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton

Product Detail

Office Supplies

Forms & Recordkeeping

Claim/Medical Forms

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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Manufacturer	TOPS Products
UPC Code	818237890116
UOM	CT

Catalog Page Number	O109
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
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
Color Family	White
Product Color	White
Certifications & Standards	American Medical Association
Recycled	No
Assembly Required	No
Country of Origin	United States
Environmental Certification	Sustainable Forestry Initiative (SFI)

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TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton