UB FORMS is a division of American HCFA Forms and DFL Enterprises, nationwide suppliers of CMS FORMS, HCFA FORMS and UB04 HEALTH INSURANCE CLAIM FORMS.
"Selling Direct to You on the Internet Since 1998"

CLAIM FORMS STARTING AT $19.99
We Have the Newest Revision of CMS-1500 FORMS (STARTING AT $19.99)
We Have the New UB-04 CLAIM FORMS (STARTING AT $19.99)

UB04 FORMS (Replaces UB92 Forms)

CMS-1500 FORMS (HCFA-1500 Forms New Revision)

HOME HEALTH FORMS CMS-485,486,487 FORMS (HCFA-485, 486, 487)

CLAIM FORM ENVELOPES (CMS/HCFA 1500, UB-04)

HIPAA COMPLIANCE FORMS
HIPAA Information
HIPAA Compliant Confidential Patient Sign-In Systems
HIPAA Compliant Confidential Patient Sign-In System with adhesive strips
Confidential Sign-In Logs (Generic)
HIPAA Employee Training Record
(Form #101)
HIPAA Practice Training Record
(Form #102)
Protected Health Information (PHI) Access Log
(Form #103)
Protected Health Information (PHI) Disclosure Log
(Form #104)
Patient Request for Amendment of Health Information
(Form #105)

HIPAA COMPLIANCE FORMS
Patient Requests for Accounting of Disclosures
(Form # 106)
Patient Request to Inspect/Review PHI
(Form #107)
Patient Request for Confidential Communications
(Form #108)
Patient Request for Restrictions on Use & Disclosure of PHI
(Form #109)
PHI Tracking Log
(Form #110)
Authorization to Release Information
(Form #111)
Notice of Privacy Practices
(Form #120)
Notice of Privacy Practices
Spanish Version
(Form #120S)
 

NARCOTIC CONTROL RECORDS
Drug Administration Records
with Pharmacy Receipts
(DNC10)
Drug Administration Records
with Pharmacy Receipts
(DNC25)
Controlled Drug Administration Records
(D150-10)
Controlled Drug Administration Records
(D150-25)
Controlled Drug Administration Records
(D250-10)
Controlled Drug Administration Records
(D250-25)

ENVELOPES
Claim Form Envelopes
Dental X-Ray Envelopes
Patient Valuables Envelopes

LABORATORY MOUNT SHEETS
Physician's Telephone Orders (DTO4)
Physician's Telephone Messages (DTM4)
Laboratory Reports (DC5)
Laboratory Reports (DD5)
Laboratory Reports (DVT3)
Laboratory Reports (DVT5)
Laboratory Reports (DVT13)
Laboratory Reports (DVT5)
Laboratory Reports (DH3)
Laboratory Reports (DH5)

PHYSICIAN'S ORDER SHEETS
Physician's Order Sheets (DPO3)
Physician's Order Sheets (DPO4)
Physician's Order Sheets (DPO5)
 

ALL OUR FORMS ARE OF THE HIGHEST QUALITY, ARE PRINTED IN STRICT COMPLIANCE WITH GOVERNMENT SPECIFICATIONS AND ARE APPROVED BY CENTERS FOR MEDICARE AND MEDICAID SERVICES AND THE INSURANCE INDUSTRY.
UB Forms and American HCFA Forms are divisions of DFL Enterprises, Inc., an independent supplier of US Government approved claim forms and NOT an affiliate of CMS (www.cms.gov)

UB04 FORMS (New UB04 Forms replace UB92 Forms)

We still have the Old Version UB-92 forms available in our On-Line Store CLICK HERE

Discounts available for large quantities.  Contract pricing available.  Call for details.

CMS-1500 (HCFA-1500) CLAIM FORMS
(New Revision Replaces Old HCFA-1500 Forms)

We still have the Old Version  HCFA-1500 forms available in our On-Line Store CLICK HERE

Discounts available for large quantities.  Contract pricing available.  Call for details.

HOME HEALTH FORMS CMS 485,486,487 (HCFA 485, 486, 487)

CLICK IMAGE TO ENLARGE

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CONTACT US TOLL FREE AT:
1-877-840-1500
8-5 Mon-Fri CST

Description

Qty./
Case

Price/
Case

CLICK HERE TO

CMS 485/HCFA 485
4 Part Continuous

500

$55.00

CMS 486/HCFA 486
3 Part Continuous

1000

$75.00

CMS 487/HCFA 487
4 Part Continuous

500

$55.00

HCFA/CMS 1500, UB-04 CLAIM FORM ENVELOPES

These envelopes are available in right hand window only.
All envelopes are self-seal and have security liner .

Your return address can be imprinted in the upper left.
Call for imprinting details. 1-877-840-1500

These envelopes are available in right hand window only.
All envelopes are self-seal and have security liner.

Your return address can be imprinted in the upper left.
Call for imprinting details. 1-877-840-1500

CLICK IMAGE TO ENLARGE

NEW! - New envelope for the UB04 claim form - NEW!

New envelope for the UB04 claim form. Simply fold the UB04 in half and insert! The envelope has an inside tint for HIPAA compliance and moistenable gum flap. The size is 9"x 5-13/16".
 
Your return address can be imprinted in the upper left.
Call for imprinting details. 1-877-840-1500

Inside tint for HIPAA compliance.

These envelopes are available in left hand window only.
All envelopes are self-seal and have security liner.

Your return address can be imprinted in the upper left.
Call for imprinting details. 1-877-840-1500

These envelopes are available in left hand window only.
All envelopes are self-seal and have security liner.

Your return address can be imprinted in the upper left.
Call for imprinting details. 1-877-840-1500

CLICK IMAGE TO ENLARGE

UB04  |  CMS/HCFA 1500  |  CMS/HCFA 485, 486, 487