Material Handling Solutions Llc 
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Product Categories:
  • Abrasives
  • Adhesives, Sealants and Tapes
  • Barriers
  • Bins
  • Breakroom and Janitorial
  • Cabinets
  • Cafeteria Tables
  • Canopies/Shelters
  • Cantilever Racks
  • Carts
  • Casters
  • Chairs & Stools
  • Chemicals, Lubricants and Paints
  • Cleaners / Wipes
  • Commercial Laundry Machines
  • Containers
  • Conveyors
  • Cranes
  • Desks / Tables
  • Display Shelving
  • Dock Equipment
  • Dollies
  • Drums & Equipment
  • Electrical and Lighting
  • Electrical Tools
  • Fans & Heaters
  • Fasteners, Clamps and Straps
  • Forklifts
  • Hand Tools
  • Hand Trucks
  • Hoists & Equipment
  • Hose & Cord Reels
  • HVAC
  • Janitorial Equipment
  • Janitorial Supplies
  • Ladders
  • Lifts
  • Lifts / Lifting Equipment
  • Lockers
  • Marking Tools
  • Material Handling
  • Matting
  • Measuring and Leveling Tools
  • Mezzanines
  • Miscellaneous
  • Mobile Cabinets
  • MRO Supplies
  • Office Furniture
  • Office Supplies
  • Oilfield
  • Pallet Racks
  • Pallet Trucks
  • Pallets & Equipment
  • Plastic Pallets
  • Plumbing Equipment
  • Pneumatics
  • Power Tools
  • Pumps
  • Rack Systems
  • Safety and Security
  • Safety Equipment
  • Scales
  • Shelving
  • Shipping Supplies
  • Shop Desks & Tables
  • Strobe Lights
  • Tables & Table Movers
  • Tape
  • Technology
  • Tilt Trucks & Hoppers
  • Tool Control
  • Tools
  • Trucks
  • Used Forklifts
  • Warehouse Equipment
  • Welding Supplies
  • Wipes & Cleaners
  • Wire Partitions
  • Work Benches



    • Tops® Ub04 Hospital Insurance Claim Form printable version

    • Printed to Government Printing Office standards.
    • OCR ink for scanning.
    • American Medical Association (AMA) approved format.
    Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format.

    Click on the Product No(s). below to view further information and order now!


    Product No. TOP59870R
    Global Product Type Forms-Insurance Claim
    Form Type Insurance Claim
    Format Loose Form
    Form Size (W x H) 8 1/2 in x 11 in
    Form Size 8 1/2 x 11
    Forms Per Page 1
    Sheet Size 8 1/2 X 11
    Form Quantity 2500
    Layout One Form per Sheet
    Punching
    Printer Compatibility Laser
    Paper Stock 20-lb.
    Paper Color(s) White
    Print and Ruling Color(s) Red
    Form Special Features For Laser Printers
    Pre-Consumer Recycled Content Percent 0 %
    Post-Consumer Recycled Content Percent 0 %
    Total Recycled Content Percent 0 %
    Price
    CT$186.97


    Product No. TOP59770R
    Global Product Type
    Form Type Insurance Claim
    Format Continuous Form
    Form Size (W x H)
    Form Size 8 1/2 x 11
    Forms Per Page
    Sheet Size
    Form Quantity
    Layout One Form per Sheet
    Punching Dot Matrix Holes
    Printer Compatibility Dot Matrix
    Paper Stock 20-lb.
    Paper Color(s) White
    Print and Ruling Color(s) Red
    Form Special Features
    Pre-Consumer Recycled Content Percent 0 %
    Post-Consumer Recycled Content Percent 0 %
    Total Recycled Content Percent 0 %
    Price
    CT$139.23



     

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