TOPS
TOP59870R - UB04 Hospital Insurance Claim Form
Free shipping with 3 or more products in your cart
R 11,343
In stock
Duties, insurance and VAT included
Delivered in 10–20 working days —
Free shipping with 3 or more products in your cart
Secure checkout
Your payment is fully protected
Duties & VAT included
No surprise charges at the door
Tracked delivery
Track your order end to end
Returns support
30-day return window
Description
- Continuous forms are designed for hospitals to file a claim with the patient's insurance company
- Forms are printed to GPO standards in OCR ink on 20 lb. bond
- Health Care Finance Administration format ensures accuracy in reporting all necessary information
- 11" Length x 8.50" Width; 2500 / Carton
- Replaces the UB-92
Technical Specifications
Manufacturer
TOPS Products
Model
Tops 59870R
Height
27.9 cm
Length
29.2 cm
Width
21.6 cm
Weight
26 kg
Shipping & Delivery
Your order is shipped from the USA and delivered to your door in South Africa in 10–20 working days. All items are fully tracked.
Returns & Exchanges
We offer a 30-day return window. If something isn't right, contact our support team and we'll make it right.