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Claim/Medical Forms

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  1. TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton
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  1. TOP59870R
  2. TOPS 1-part UB-04 Laser-cut Forms - 1 Part - 11" x 8.50" Form Size - White - Red Print Color - 2500 / Carton
    • 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
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$278.37   CT
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  1. TOPS CMS-15000 Health Insurance Claim Forms - 20 lb - 11" x 8.50" Sheet Size - White Sheet(s) - Red Print Color - 250 / Pack
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  1. TOP50135RV
  2. TOPS CMS-15000 Health Insurance Claim Forms - 20 lb - 11" x 8.50" Sheet Size - White Sheet(s) - Red Print Color - 250 / Pack
    • CMS, NUCC and OMB approved format
    • Printed front and back
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$29.40   PK
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