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Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format.

TOPS&#153; UB04 Hospital Insurance Claim Form for Laser Printers, 8.5&quot; x 11&quot;, 2,500 Forms Total

laser-ub-04-claim-forms-1-part-8-1-2-x-11-white-2500-forms-carton

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TOPS™ UB04 Hospital Insurance Claim Form for Laser Printers, 8.5" x 11", 2,500 Forms Total