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Adams UB-04 Continuous Hospital Insurance Claim Form, 1 Part, Laser, 8.5 x 11 Inches, 2500 Sets per Carton, White (59870R) - TOPS TOPS 59870R UPC   025932598708 UB-04 claim forms used by hospitals file a claim with the patient's insurance company, replaces the UB-92 form Forms are printed to GPO standards in OCR ink on 20 pound stock bond Laser cut sheets 2,500 sets per carton 8.5 x 11 inch sheet size

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