CMS 1500 Claim Forms - HCFA (Version 02/12) 2,500 Sheets, Approved OMB-0938-1197

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2,500 Single Sheets - Printed in OCR red (Version 02/12) APPROVED OMB-0938-1197 Size: 8-1/2" X 11"; Weight: 24# Paper For Laser and/or Inkjet Printers

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