Tops Medicare/Medicaid Services Claim Forms CMS1500/HCFA1500 500 Forms 50126RV

TOPS™ Centers for Medicare and Medicaid Services (CMS) Forms

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. Laser Printer Compatible. Form Type Details: CMS-1500; Dated: No; Forms Per Page: 1; Form Size: 8.5 x 11.

• Special Features: Laser Printer Compatible
• Total Recycled Content Percent: 0%
• Post-Consumer Recycled Content Percent: 0%
• Pre-Consumer Recycled Content Percent: 0%
• Product Compostability Indicator: N
• Product Biodegradability Indicator: N
• Print and Ruling Color(s): OCR Red
• Paper Stock: 20 lb Bond
• Printer Compatibility: Laser
• Color Family: White
• Paper Color(s): White
• Principal Heading(s): 1500 Health Insurance Claim Form
• Copy Types: One-Part (No Copies)
• Form Quantity (Total): 500
• Format Indicator: Unbound
• Form Size: 8.5 x 11
• Forms Per Page: 1
• Dated: No
• Global Product Type: Insurance Forms
• Form Type Details: CMS-1500

WARNING: This product can expose you to chemicals including Di(2-ethylhexyl)phthalate (DEHP), which is known to the State of California to cause cancer and birth defects or other reproductive harm. For more information, go to www.P65Warnings.ca.gov.

• This item cannot be shipped to PO Boxes.
• This item can be shipped only within the U.S.

• UPC: 025932512605 
• Mfr's Part #: 50126RV 

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