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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
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Item:
TOP59870R
- 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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General Information
Manufacturer
TOPS Products
Manufacturer Part Number
59870R
Manufacturer Website Address
https://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
Catalog
General Line W-Catalog
Catalog Page
N/A
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
Product Color
White
Miscellaneous
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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