Tops - TOP59870R - UB04 Hospital Insurance Claim Form
$144.51
Description
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
