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UB92 Hospital Claim Form Product code: TOP 59770 Manufacturer: Tops
Price:
$91.88
per carton
2,500 Forms per Carton
One-Part Form
Continuous Form
UB92 Hospital Claim Form • American Medical Association (AMA) approved format For filing claims with patients’ insurance carriers. Printed to Government Printing Office standards with OCR red ink for scanning. 20-lb. paper. Continuous Form 8-1/2 x 11 detached size. 2,500 Forms per Carton One-Part Form 8-1/2 x 11 detached size.
All brands and product names are trademarked or registered trademarks of their
respective companies. Prices, specifications, and availability are subject to change without notification.
E.&O.E. Image & Description provided by and used with permission from The Betty Mills Company. Page revised: Thursday, August 17, 2006.
This page is at http://www.shopmontgomerystore.com/bettymills/go/top-59770
