FORM,UB-04,2PART CONTINUOUS

Product Description
Each form meets the requirements of the Centers for Medicare and Medicaid Services (CMS).Printed in OCR Black ink on perforated, carbonless, 20 lb paper to ensure better scanning and reproduction. 2 PartWhite9.5 in x 11 in Continuous UB-04 Forms – 9.5 in x 11 in – TOPS – 59772R
FORM,UB-04,2PART CONTINUOUS

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