FORM,UB-04,1-PT,LASER,WE
| Item Id | 628058 |
| Manufacturer # | TOP-59870R |
| Manufacturer | TOPS™ |
| Country of Origin | United States |
| Color Family | White |
| Copy Types | One-Part (No Copies) |
| Dated/Undated | Undated |
| Form Quantity (Total) | 2,500 |
| Form Size | 8.5 x 11 |
| Form Type Details | UB04 |
| Format Indicator | Unbound |
| Forms Per Page | 1 |
| Global Product Type | Insurance Forms |
| Is_Active_Vendor | Y |
| Is_DSCSA | N |
| Is_Discontinued | N |
| Is_Medical_Device | N |
| Lot_Tracking_Flag | N |
| On_Allocation | N |
| Paper Color(s) | White |
| Paper Stock | 20 lb Bond |
| Post-Consumer Recycled Content Percent | 0% |
| Pre-Consumer Recycled Content Percent | 0% |
| Print and Ruling Color(s) | Red |
| Printer Compatibility | Laser |
| Special Features | Laser Printer Compatible |
| Supplier_ID | 3784663 |
| Total Recycled Content Percent | 0% |
| UNSPSC | 14111806 |
Features
- Printed to Government Printing Office standards.
- OCR ink for scanning.
- American Medical Association (AMA) approved format.
