UB-04 Hospital Claim Form for Dot-Matrix Printers, 3-Part

UB-04 Hospital Claim Form for Dot-Matrix Printers, 3-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
• 3-Part forms
• Continuous forms, compatible with Dot-Matrix printers

Manufacurer/Model: TFP UB043

Related Staples Products and Coupon Codes

Looking for more Envelopes & Forms products? Try the 7-1/2" x 10-1/2" Economy White Catalog Envelopes. Another product to consider is the General Purpose Receipt Books, 2-3/4" x 7-1/18", 2 Part.

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