UB-04 Hospital Claim Form for Dot-Matrix Printers, 2-Part
UB-04 Hospital Claim Form for Dot-Matrix Printers, 2-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
- 2-Part forms
- Continuous forms, compatible with Dot-Matrix printers
Manufacurer/Model: TFP UB042
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