Description
PRODUCT DETAILS
Expedite Medicare, Medicaid or private insurance benefits. NUCC, CMS and AMA approved format. (02/12) version. Printed front and back in red OCR ink for scanning.
COLOR: White
ALTERNATE ITEM #: 836952, B0013CNXDK
UPC: 025932513503
ITEM #: TOP50135R
Product Type: General Forms
White General Forms 1095 In Stock today.
Details
Case Pack: |
Each |
Color: |
White |
Dimensions: |
8 1/2 x 11" " |
Form Quantity: |
250 |
Form Size: |
8.5 x 11 |
Format: |
Loose Form |
Forms Per Page: |
1 |
Global Product Type: |
Forms-Insurance |
Layout: |
One Form per Sheet |
Manufacturer Name: |
TOPS |
Paper Color(s): |
White |
Paper Stock: |
20-lb. |
Post-Consumer Recycled Content Percent: |
0% |
Pre-Consumer Recycled Content Percent: |
0% |
Principal Heading(s): |
1500 Health Insurance Claim Form |
Print and Ruling Color(s): |
OCR Red |
Printer Compatibility: |
Laser |
Product Type: |
Insurance Claim |
Special Features: |
For Laser Printers |
Total Recycled Content Percent: |
0% |
Weight: |
2.66 lb(s) |
