Form, Ub-04, 1Part Laser Pk
Mfr # TOP59870R
Zoro # G601824477
product price:Â $219.99
/pk 2500, $0.09/ea
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Specifications
Product Information
MFR #
TOP59870R
Zoro #
G601824477
UPC #
25932598708
Country of Origin
United States
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.
Restrictions
WARNING:
Cancer and Reproductive Harm
For more information go to
www.P65Warnings.ca.gov
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