Stock Health Care Forms

CMS 1500 02/12 and UB04 Claim Forms

We stock the CMS and the UB04 in 1 part, 2 part and laser cut sheet. We would be happy to give you pricing and answer any questions you may have. Please call 800-326-9583 for additional information or email sales.service@phoenixdatainc.com.

1 part continuous and cut sheets are produced on 20# OCR Laser Bond, using laser safe OCR inks. Packaged 2500/carton. (Cut sheets shrink wrapped in 500's).

2 part continuous: White 21# BP-CB and 15# CF. Packaged 1000/carton.

CMS 1500 02/12

CMS1500

  • Laser Cut Sheet (8 1/2 x 11) 1500-C
  • 1 Part Continuous (9 1/2 x 11) 1500-1
  • 2 Part Continuous (9 1/2 x 11) 1500-2

UB04

UB-04

  • Laser Cut Sheet (8 1/2 x 11) UB 04-C
  • 1 Part Continuous (9 1/2 x 11) UB 04-1
  • 2 Part Continuous (9 1/2 x 11) UB 04-2