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UB04 Insurance Claim Form, 1-Part Continuous White, 9 1/2 x 11, 2500 Forms

PRB05109

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  • Expedite Medicare, Medicaid or private insurance claims processing
  • Forms meet all Federal regulations
  • Formerly known as HCFA-1500 forms
  • Form Size: 9 1/2 x 11; Forms Per Page: 1; Form Quantity: 2500; Sheet Size: 9 1/2 x 11.
Global Product Type Forms-Insurance
Form Size 9 1/2 x 11
Forms Per Page 1
Form Quantity 2500
Sheet Size 9 1/2 x 11
Copy Types Continuous Feed
Paper Stock 20 lb.
Paper Color(s) White
Footnote 1 One-part continuous feed, white
Special Features UB04 Hospital Insurance Claim Forms