CMS 1500 Claim Forms - HCFA (Version 02/12) 2,500 SHEETS, APPROVED OMB-0938-1197
| Country | USA |
| Brand | Compuchecks |
| Manufacturer | Compuchecks |
| Binding | Office Product |
| ItemPartNumber | FBA_6505 |
| Model | 07106 |
| Size | 2500 |
| UPCs | 090146071064 |
| EANs | 0090146071064 |
| ReleaseDate | 0000-00-00 |