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Adams UB-04 Continuous Hospital Insurance Claim Form, 1 Part, Laser, 8.5 x 11 Inches, 2500 Sets per Carton, White (59870R)


List Price: $198.36
Price: $87.89 & FREE Shipping. Details
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Only 10 left in stock (more on the way).
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  • UB-04 claim forms used by hospitals file a claim with the patient's insurance company, replaces the UB-92 form
  • Forms are printed to GPO standards in OCR ink on 20 pound stock bond
  • Laser cut sheets
  • 2,500 sets per carton
  • 8.5 x 11 inch sheet size
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$87.89 & FREE Shipping. Details Only 10 left in stock (more on the way). Ships from and sold by Amazon.com. Gift-wrap available.

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Product Description

Adams Business Forms provide the tools to help keep track of messages, finances, transactions, employees, taxes, and customers to businesses throughout the world. The Adams UB-04 Hospital Insurance Claim forms are used by hospitals to file claims with the patient's insurance company. Each form is printed to GPO standards in OCR ink on a 8.5 x 11 inch laser cut sheet size, with 2,500 form sets per carton. These UB-04 forms are made to replace the UB-92 forms. These business forms are the perfect way to create and maintain a professional image for small businesses and service providers. Whether it's a multi-part form, notebooks, writing pads, record books, or any of the hundreds of items we offer, you can count on Adams products to help!

Product Information

Technical Details

Brand Name Adams
Item Weight 27 pounds
Product Dimensions 11 x 8.5 x 4.4 inches
Item model number 59870R
Color White
Number of Items 1
Size 8 1/2 In X 11 In
Manufacturer Part Number 59870R

Additional Information

ASIN B001E662W4
Customer Reviews
0.0 out of 5 stars
Best Sellers Rank #124,862 in Office Products (See top 100)
#39 in Office Products > Office Supplies > Forms, Recordkeeping & Money Handling > Human Resources Forms > Medical & Insurance Forms
#33,397 in Industrial & Scientific > Professional Medical Supplies
Shipping Weight 26.7 pounds (View shipping rates and policies)
Domestic Shipping This item is also available for shipping to select countries outside the U.S.
International Shipping This item can be shipped to select countries outside of the U.S. Learn More
Date First Available June 2, 2007

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Adams UB-04 Continuous Hospital Insurance Claim Form, 1 Part, Laser, 8.5 x 11 Inches, 2500 Sets per Carton, White (59870R)
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This item: Adams UB-04 Continuous Hospital Insurance Claim Form, 1 Part, Laser, 8.5 x 11 Inches, 2500 Sets per Carton, White (59870R)