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

195 in stock

SKU: TOP59870R
Model# 59870R

Product Details
  • 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
Brand Name: TOPS
Product Model: UB-04
Product Name: 1-part UB-04 Laser-cut Forms
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
Physical Characteristics
Color: White
Miscellaneous
Certifications & Standards:

American Medical Association

Recycled: No
Assembly Required: No
Environmentally Friendly: Yes
Environmental Certification: SFI
Country of Origin: United States

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Main Features

  • Manufacturer: TOPS Products
  • Manufacturer Part Number: 59870R
  • Brand Name: TOPS
  • Product Model: UB-04
  • Product Name: 1-part UB-04 Laser-cut Forms
  • Packaged Quantity: 2500 / Carton
  • Product Type: Claim Form

Product Description

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.

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