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TOPS UB04 Hospital Insurance Claim Form

TOPS UB04 Hospital Insurance Claim Form

Brand: MISCELLANEOUS

TOPS UB04 Hospital Insurance Claim Form - Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format. For Laser Printers.
 

  • Form Size: 8.5 x 11
  • Forms Per Page: 1
  • Form Quantity: 2500
  • Layout: One Form per Sheet.

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