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Insurance Claim Form # UB 04
FRONT / BACK view
Product Code:
UB 04
Description
Insurance Claim Form # UB 04
Laser Sheets 500 or 1000
2 part computer continuous 1000 per box
Features
Dimensions: 8.5" x 11"
Color: White Laser Paper
1 Side
(Also available in 2 Part Computer Continuous)
Related Items
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Post Discharge Plan of Care #3808 - F NCR
Physicians Orders - 3 Part NCR # 637
Nutritional Assessment # 118
Elopement Risk Tracking Log #2295
Evacuation Tag #3861
Utilization Committee Determ. On Admission #3723 NCR
Notice of Transfer / Discharge # 2703 NCR
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