Product Information:  :::::::::::::::::::::

TOPS : UB92 Hospital Claim Form
TOPS: UB92 Hospital Claim Form • American Medical Association (AMA) approved format For filing claims with patient’s insurance carrier. Forms are printed to Government Printing Office standards with OCR red ink for scanning. 20-lb. paper.

Continuous Form : 8-1/2 x 11 detached size.      Prefix and Stock Number: TOP-59770
Item # List Price Unit Qty
9970427 2,500 Forms per Carton One-Part Form $106.03 CT
For Laser Printers : 8-1/2 x 11.      Prefix and Stock Number: TOP-59870
Item # List Price Unit Qty
9970419 2,500 Forms per Carton One-Part Form $112.98 CT


  

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