UB-04 Hospital Claim Form for Dot-Matrix Printers, 1-Part

UB-04 Hospital Claim Form for Dot-Matrix Printers, 1-Part - available at Staples.com via our site. Use our links and Staples coupon codes for Staples promotions. Visit our Envelopes & Forms catalog page for more good deals.

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Product Features

• Easily file a medical claim with a patient's insurance carrier
• File a hard copy of each claim with patient records in case you need to resubmit a claim
• 1-Part forms
• Continuous forms, compatible with Dot-Matrix printers

Manufacurer/Model: TFP UB041

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