# TOPS™ UB04 Hospital Insurance Claim Form for Laser Printers, One-Part (No Copies), 8.5 x 11, 2,500 Forms Total

-   Printed to Government Printing Office standards.
-   OCR ink for scanning.
-   American Medical Association (AMA) approved format.

Printed to Government Printing Office standards. OCR ink for scanning. American Medical Association (AMA) approved format.

## Details

- **Price:** 194.78 USD
- **Vendor:** TOPS™
- **Type:** Forms
- **Tags:** Claim Form, Claim Forms, Continuous Form, Documents, HCFA Claim Form, Health Care Claim Forms, Human Resources, Insurance Forms, Paperwork, Personnel, Personnel Forms, Pre-Printed, Record-Keeping, Records, TOPS, UB04

## Variants

| Variant | Price | Available |
|---------|-------|-----------|
| Default Title | 194.78 USD | In stock |

## Images

- UB04 Hospital Insurance Claim Form | 2500-ct

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> Source: [Bloom Skins](https://www.bloomskins.com/products/ub04-hospital-insurance-claim-form-for-laser-printers-one-part-no-copies-8-5-x-11-2-500-forms-total)
> Updated: 2026-04-02