Tops UB04 Hospital Insurance Claim Form One-Part 8.5 x 11 2500 Forms 59870R


TOPS™ UB04 Hospital Insurance Claim Form
Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format. Laser Printer Compatible. Form Type Details: UB04; Dated: No; Forms Per Page: 1; Form Size: 8.5 x 11.
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- This item cannot be shipped to PO Boxes.
- This item can be shipped only within the U.S.
- UPC: 025932598708
- Mfr's Part #: 59870R