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UB-04 Hospital Claim Form for Dot-Matrix Printers, 2-Part

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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