UB-04 (CMS 1450) Health Hospital Insurance Claim Form, Laser 8-1/2 x 11" 100 Forms Per Pack 1" x 2-5/8" - 30 Per Page - 30 Made in USA by Next

Made in USA by Next Day Labels TM

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UB-04 (CMS 1450) Health Hospital Insurance Claim Form, Laser 8-1/2 x 11" 100 Forms Per Pack 1" x 2-5/8" - 30 Per Page - 30 Made in USA by NextCMS 1450 UB 04 Form Next Day Labels UB04 CMS 1450 forms are completely compliant with NUBC format and coding requirements: Pack of 100 Sheets 8 1 2 x 11, Letter Size 1 part Laser Ink Jet Form All fields, boxes, and Layout consistently to line up 100% with billing software Printed in the USA by Next Day Labels TM with red OCR ink GPO standards All forms adhere to strict government standards developed by HIPAA in accordance with American Hospital