Insurance/UB04 Hospital Claim, 8-1/2 x 11, 2500 Continuous Forms/Carton
Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format. Global Product Type: Forms-Insurance Claim; Form Size (W x H): 8 1/2 in x 11 in; Format: Continuous Form; Forms Per Page: N/A.
TOP 59770R, TOP-59770R, TOP,59770R