UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total, GENERAL FORMS - GoAVM.com
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UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total

Quick Find
: 9461823

Casepack
: 2500

UOM
: CT

Model #
: 59870R

SKU
: TOP59870R

Product Description

Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format. Laser Printer Compatible. Form Type Details: UB04; Dated/Undated: Undated; Forms Per Page: 1; Form Size: 8.5 x 11.