You can fill in the attached forms electronically, using Adobe Form Filler, as long as you have Adobe Acrobat Reader. (If you need the free reader, you can download it from www.adobe.com.) First, save the file to your computer. Once you have completed the form, be sure to select “save as” and re-name the file per your instructor’s direction (or use this naming convention: lastname_firstname_chapter#.xxx). You can then print the form or email it to your instructor as needed.

Sample Claims Form 1 (456.0K)

Sample Claims Form 2 (401.0K)

Sample Claims Form 3 (445.0K)

UB04 Form (565.0K)