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TOP59870R

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TOPS Products
TOPS 1-part UB-04 Laser-cut Forms
1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton

Product Details

  • Continuous forms are designed for hospitals to file a claim with the patient's insurance company
  • Forms are printed to GPO standards in OCR ink on 20 lb. bond
  • Health Care Finance Administration format ensures accuracy in reporting all necessary information
  • 11" Length x 8.50" Width; 2500 / Carton
  • Replaces the UB-92
UPSOK AboutBrand
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Detail
General Information
Manufacturer TOPS Products
Manufacturer Part Number 59870R
Manufacturer Website Address http://www.tops-products.com
Brand Name TOPS
Product Model UB-04
Product Name 1-part UB-04 Laser-cut Forms
Marketing Information UB-04 laser-cut forms are designed for medical offices to file a claim with the patient's insurance company. The Health Care Finance Administration format ensures accuracy in reporting all necessary information. Forms meet the requirements of the Centers for Medicare and Medicaid Services (CMS). Forms are printed on 20 lb. bond paper.
Packaged Quantity 2500 / Carton
Product Type Claim Form
Product Information
Number of Forms per Sheet 1
Form Length 11"
Form Width 8.50"
Number of Parts 1
Printed Side Front
Print Color Red
Print Technology Laser
Physical Characteristics
Color Family White
Product Color White
Miscellaneous
Certifications & Standards American Medical Association
Recycled No
Assembly Required No
Country of Origin United States
Environmental Certification Sustainable Forestry Initiative (SFI)
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Ritter's Office Outfitters 2025

Phone: 800-545-8000

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TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton TOP59870R TOPS 1-part UB-04 Laser-cut Forms 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton