UB04 Hospital Insurance Claim Form, 8 1/2 x 11, 2,500 Forms, Sold as 2500 Each by Tops at Pulmonomics. MPN: PLX393954. Hurry! Limited time offer. Offer valid only while supplies last. Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format. Form Size: 11 x 8 1/2; Forms Per Page: 1; Form Quantity: 2500; Layout: One Form per Sheet.UB04 hospital insurance claim form.. Printed to Government Printing Office standards.. OCR ink for scanning.. American Medical Association (AMA) approved format..
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