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Global: ^IBA(364.7

Package: Integrated Billing

Global: ^IBA(364.7


Information

FileMan FileNo FileMan Filename Package
364.7 IB FORM FIELD CONTENT Integrated Billing

Description

Accessed By FileMan Db Calls, Total: 26

Package Total Routines
Integrated Billing 26 IB20P109    IB20P207    IB20P350    IB20P644    IB488PRE    IBCEFG4    IBCEFG41    IBCEFG5
IBCEFG6    IBCEFG60    IBCEFG61    IBCEU4    IBY232PO    IBY280PR    IBY296PR    IBY320PR
IBY323PR    IBY349PR    IBY371PR    IBY400PR    IBY403PR    IBY447PR    IBYOPOST    IBYOPRE
IBYPPCC    IBYPPR    

Pointer To FileMan Files, Total: 3

Package Total FileMan Files
Integrated Billing 3 INSURANCE COMPANY(#36)[.05]    IB DATA ELEMENT DEFINITION(#364.5)[.03]    IB FORM SKELETON DEFINITION(#364.6)[.01]    

Fields, Total: 12

Field # Name Loc Type Details
.01 FORM FIELD REFERENCE 0;1 POINTER TO IB FORM SKELETON DEFINITION FILE (#364.6)
************************REQUIRED FIELD************************
IB FORM SKELETON DEFINITION(#364.6)

  • LAST EDITED:  APR 28, 2000
  • HELP-PROMPT:  Enter the billing form that this field is associated with
  • DESCRIPTION:  
    This is a pointer to the billing form field that this field is associated with.
  • CROSS-REFERENCE:  364.7^B
    1)= S ^IBA(364.7,"B",$E(X,1,30),DA)=""
    2)= K ^IBA(364.7,"B",$E(X,1,30),DA)
  • CROSS-REFERENCE:  364.7^ATYPE^MUMPS
    1)= N Z1,Z0 S Z0=$G(^IBA(364.7,DA,0)),Z1=$P(Z0,U,6) I Z1'="",$P($G(^IBA(364.6,+X,0)),U,3),'$P(Z0,U,5) S ^IBA(364.7,"ATYPE",$P(^IBA(364.6,+X,0),U,3),Z1,DA)=""
    2)= N Z0,Z1 S Z0=$G(^IBA(364.7,DA,0)),Z1=$P(Z0,U,6) I Z1'="",$P($G(^IBA(364.6,+X,0)),U,3) K ^IBA(364.7,"ATYPE",$P(^IBA(364.6,+X,0),U,3),Z1,DA)
    3)= DO NOT DELETE
    Xref by form and bill type
  • CROSS-REFERENCE:  364.7^AINTYP^MUMPS
    1)= N Z0,Z1,Z2 S Z0=$G(^IBA(364.7,DA,0)),Z1=$P(Z0,U,5),Z2=$P(Z0,U,6) I Z1,Z2'="",$P($G(^IBA(364.6,+X,0)),U,3) S ^IBA(364.7,"AINTYP",$P(^IBA(364.6,+X,0),U,3),Z1,Z2,DA)=""
    2)= N Z0,Z1,Z2 S Z0=$G(^IBA(364.7,DA,0)),Z1=$P(Z0,U,5),Z2=$P(Z0,U,6) I Z1,Z2'="",$P($G(^IBA(364.6,+X,0)),U,3) K ^IBA(364.7,"AINTYP",$P(^IBA(364.6,+X,0),U,3),Z1,Z2,DA)
    3)= DO NOT DELETE
    Xref by form, insurance company and bill type
  • CROSS-REFERENCE:  364.7^AINS^MUMPS
    1)= N Z0,Z1 S Z0=$G(^IBA(364.7,DA,0)),Z1=$P(Z0,U,5) I Z1,$P($G(^IBA(364.6,+X,0)),U,3),$P(Z0,U,6)="" S ^IBA(364.7,"AINS",$P(^IBA(364.6,+X,0),U,3),Z1,DA)=""
    2)= N Z0,Z1 S Z0=$G(^IBA(364.7,DA,0)),Z1=$P(Z0,U,5) I Z1,$P($G(^IBA(364.6,+X,0)),U,3) K ^IBA(364.7,"AINS",$P(^IBA(364.6,+X,0),U,3),Z1,DA)
    3)= DO NOT DELETE
    Xref by form field and insurance company
  • FIELD INDEX:  ALL (#52) MUMPS IR SORTING ONLY
    Short Descr: Xref contains all local overrides defined for all insurance and type
    Set Logic: S ^IBA(364.7,"ALL",X2(2),DA)=""
    Set Cond: I 'X2(2)!(X2(4)'="")!(X2(5)'="")!(X2(3)'="L") S X=0
    Kill Logic: K ^IBA(364.7,"ALL",X1(2),DA)
    Kill Cond: I 'X1(2)!(X1(4)'="")!(X1(5)'="")!(X1(3)'="L") S X=0
    Whole Kill: K ^IBA(364.7,"ALL")
    X(1): FORM FIELD REFERENCE (364.7,.01) (Len 15) (forwards)
    Transform (Display):
    X(2): Computed Code: S X=$P($G(^IBA(364.6,+X(1),0)),U,3)
    (Subscr 1) (Len 10)
    X(3): SECURITY LEVEL (364.7,.02) (Len 10) (forwards)
    Transform (Display):
    X(4): INSURANCE COMPANY (364.7,.05) (Len 20) (forwards)
    Transform (Display):
    X(5): BILL TYPE (364.7,.06) (Len 20) (forwards)
    Transform (Display):
.02 SECURITY LEVEL 0;2 SET
  • 'N' FOR NATIONAL,NO EDIT;
  • 'L' FOR LOCAL;

  • LAST EDITED:  APR 28, 2000
  • HELP-PROMPT:  Enter N for nationally released fields (no edit) or L for locally added fields.
  • DESCRIPTION:  
    This field determines whether or not editing of the entry is allowed. For NATIONAL (N) field, no local editing is allowed. If LOCAL (L) field is created, editing is allowed.
  • FIELD INDEX:  ALL (#52) MUMPS IR SORTING ONLY
    Short Descr: Xref contains all local overrides defined for all insurance and type
    Set Logic: S ^IBA(364.7,"ALL",X2(2),DA)=""
    Set Cond: I 'X2(2)!(X2(4)'="")!(X2(5)'="")!(X2(3)'="L") S X=0
    Kill Logic: K ^IBA(364.7,"ALL",X1(2),DA)
    Kill Cond: I 'X1(2)!(X1(4)'="")!(X1(5)'="")!(X1(3)'="L") S X=0
    Whole Kill: K ^IBA(364.7,"ALL")
    X(1): FORM FIELD REFERENCE (364.7,.01) (Len 15) (forwards)
    Transform (Display):
    X(2): Computed Code: S X=$P($G(^IBA(364.6,+X(1),0)),U,3)
    (Subscr 1) (Len 10)
    X(3): SECURITY LEVEL (364.7,.02) (Len 10) (forwards)
    Transform (Display):
    X(4): INSURANCE COMPANY (364.7,.05) (Len 20) (forwards)
    Transform (Display):
    X(5): BILL TYPE (364.7,.06) (Len 20) (forwards)
    Transform (Display):
.03 DATA ELEMENT 0;3 POINTER TO IB DATA ELEMENT DEFINITION FILE (#364.5) IB DATA ELEMENT DEFINITION(#364.5)

  • LAST EDITED:  JUL 02, 1996
  • HELP-PROMPT:  Enter the data element that will define this form field. If used on a screen, it must be a fileman type.
  • DESCRIPTION:  
    This identifies the data element that be extracted for this entry.
  • TECHNICAL DESCR:  This is the data element that will be allowed to be displayed/edited on a screen, extracted for a transmit, or printed on a printed form. If used on a screen, the data element must be a fileman type and a local field
    (>10000 for ifn and on a node >10000) to be editable.
  • CROSS-REFERENCE:  364.7^C
    1)= S ^IBA(364.7,"C",$E(X,1,30),DA)=""
    2)= K ^IBA(364.7,"C",$E(X,1,30),DA)
    3)= DO NOT DELETE
    Xref by DATA ELEMENT NAME
.04 SCREEN PROMPT 0;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>70!($L(X)<1) X I $D(X),$P($G(^IBE(353,+$G(^IBA(364.6,+$G(^IBA(364.7,DA,0)),0)),2)),U,2)'="S" K X
  • LAST EDITED:  MAR 21, 1996
  • HELP-PROMPT:  Answer must be 1-70 characters in length.
  • DESCRIPTION:  
    This is used only by screen-type forms to place a prompt on the screen for a particular field.
  • TECHNICAL DESCR:  
    This is the prompt that will preceed the data element defined for this entry. If no data element, this prompt will display. This field is only used for screen-type forms.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
.05 INSURANCE COMPANY 0;5 POINTER TO INSURANCE COMPANY FILE (#36) INSURANCE COMPANY(#36)

  • LAST EDITED:  APR 28, 2000
  • HELP-PROMPT:  Enter the name of the insurance company that this field is associated with.
  • DESCRIPTION:  
    This is the insurance company who has a need for other than the standard data in this field.
  • CROSS-REFERENCE:  364.7^AINS1^MUMPS
    1)= N Z0,Z1 S Z0=$G(^IBA(364.7,DA,0)),Z1=$P($G(^IBA(364.6,+Z0,0)),U,3) I Z1,$P(Z0,U,6)="" S ^IBA(364.7,"AINS",Z1,$E(X,1,30),DA)=""
    2)= N Z0,Z1,Z2 S Z0=$G(^IBA(364.7,DA,0)),Z1=$P($G(^IBA(364.6,+Z0,0)),U,3),Z2=$P(Z0,U,6) K ^IBA(364.7,"AINS",Z1,$E(X,1,30),DA) I Z2'="",$D(^IBA(364.7,"AINTYP",Z1,X,Z2,DA)) S ^IBA(364.7,"ATYPE",Z1,Z2,DA)=""
    3)= DO NOT DELETE
    Xref by form field and insurance company.
  • CROSS-REFERENCE:  364.7^AINTYP1^MUMPS
    1)= N Z0,Z1,Z2 S Z0=$G(^IBA(364.7,DA,0)),Z1=+$P($G(^IBA(364.6,+Z0,0)),U,3),Z2=$P(Z0,U,6) I Z1,Z2'="" S ^IBA(364.7,"AINTYP",Z1,$E(X,1,30),Z2,DA)="" K ^IBA(364.7,"ATYPE",Z1,Z2,DA),^IBA(364.7,"AINS",Z1,X,DA)
    2)= N Z0,Z1,Z2 S Z0=$G(^IBA(364.7,DA,0)),Z1=+$P($G(^IBA(364.6,+Z0,0)),U,3),Z2=$P(Z0,U,6) K:Z1&(Z2'="") ^IBA(364.7,"AINTYP",Z1,$E(X,1,30),Z2,DA)
    3)= DO NOT DELETE
    Xref by insurance company and bill type
  • FIELD INDEX:  ALL (#52) MUMPS IR SORTING ONLY
    Short Descr: Xref contains all local overrides defined for all insurance and type
    Set Logic: S ^IBA(364.7,"ALL",X2(2),DA)=""
    Set Cond: I 'X2(2)!(X2(4)'="")!(X2(5)'="")!(X2(3)'="L") S X=0
    Kill Logic: K ^IBA(364.7,"ALL",X1(2),DA)
    Kill Cond: I 'X1(2)!(X1(4)'="")!(X1(5)'="")!(X1(3)'="L") S X=0
    Whole Kill: K ^IBA(364.7,"ALL")
    X(1): FORM FIELD REFERENCE (364.7,.01) (Len 15) (forwards)
    Transform (Display):
    X(2): Computed Code: S X=$P($G(^IBA(364.6,+X(1),0)),U,3)
    (Subscr 1) (Len 10)
    X(3): SECURITY LEVEL (364.7,.02) (Len 10) (forwards)
    Transform (Display):
    X(4): INSURANCE COMPANY (364.7,.05) (Len 20) (forwards)
    Transform (Display):
    X(5): BILL TYPE (364.7,.06) (Len 20) (forwards)
    Transform (Display):
.06 BILL TYPE 0;6 SET
  • 'I' FOR INPATIENT;
  • 'O' FOR OUTPATIENT;

  • LAST EDITED:  APR 28, 2000
  • HELP-PROMPT:  Enter the type of the bill.
  • DESCRIPTION:  
    This is the type of bill that requires this field.
  • CROSS-REFERENCE:  364.7^ATYPE1^MUMPS
    1)= N Z0,Z1 S Z0=$G(^IBA(364.7,DA,0)),Z1=$P($G(^IBA(364.6,+Z0,0)),U,3) I Z1,'$P(Z0,U,5) S ^IBA(364.7,"ATYPE",Z1,$E(X,1,30),DA)=""
    2)= N Z0,Z1,Z2 S Z0=$G(^IBA(364.7,DA,0)),Z1=$P($G(^IBA(364.6,+Z0,0)),U,3),Z2=$P(Z0,U,5) I Z1 K ^IBA(364.7,"ATYPE",Z1,$E(X,1,30),DA) I Z2,$D(^IBA(364.7,"AINTYP",Z1,Z2,X,DA)) S ^IBA(364.7,"AINS",Z1,Z2,DA)=""
    3)= DO NOT DELETE
    Xref by form and bill type.
  • CROSS-REFERENCE:  364.7^AINTYP2^MUMPS
    1)= N Z0,Z1,Z2 S Z0=$G(^IBA(364.7,DA,0)),Z1=+$P($G(^IBA(364.6,+Z0,0)),U,3),Z2=$P(Z0,U,5) I Z1,Z2 K:'$D(^IBA(364.7,"AINTYP",Z1,Z2,X,DA)) ^IBA(364.7,"AINS",Z1,Z2,DA) S ^IBA(364.7,"AINTYP",Z1,Z2,$E(X,1,30),DA)=""
    2)= N Z0,Z1,Z2 S Z0=$G(^IBA(364.7,DA,0)),Z1=+$P($G(^IBA(364.6,+Z0,0)),U,3),Z2=$P(Z0,U,5) K:Z1&Z2 ^IBA(364.7,"AINTYP",Z1,Z2,$E(X,1,30),DA)
    3)= DO NOT DELETE
    Xref by form, insurance company and bill type
  • FIELD INDEX:  ALL (#52) MUMPS IR SORTING ONLY
    Short Descr: Xref contains all local overrides defined for all insurance and type
    Set Logic: S ^IBA(364.7,"ALL",X2(2),DA)=""
    Set Cond: I 'X2(2)!(X2(4)'="")!(X2(5)'="")!(X2(3)'="L") S X=0
    Kill Logic: K ^IBA(364.7,"ALL",X1(2),DA)
    Kill Cond: I 'X1(2)!(X1(4)'="")!(X1(5)'="")!(X1(3)'="L") S X=0
    Whole Kill: K ^IBA(364.7,"ALL")
    X(1): FORM FIELD REFERENCE (364.7,.01) (Len 15) (forwards)
    Transform (Display):
    X(2): Computed Code: S X=$P($G(^IBA(364.6,+X(1),0)),U,3)
    (Subscr 1) (Len 10)
    X(3): SECURITY LEVEL (364.7,.02) (Len 10) (forwards)
    Transform (Display):
    X(4): INSURANCE COMPANY (364.7,.05) (Len 20) (forwards)
    Transform (Display):
    X(5): BILL TYPE (364.7,.06) (Len 20) (forwards)
    Transform (Display):
.07 PAD CHARACTER 0;7 SET
  • 'ZL' FOR ZERO PAD ON LEFT;
  • 'ZR' FOR ZERO PAD ON RIGHT;
  • 'SL' FOR SPACE PAD ON LEFT;
  • 'SR' FOR SPACE PAD ON RIGHT;
  • 'N' FOR NO PAD REQUIRED;

  • LAST EDITED:  JAN 26, 1996
  • HELP-PROMPT:  Enter the code that corresponds to the format and pad character to use for the data output in this field.
  • DESCRIPTION:  
    If present, this defines the character to be used to pad the DATA ELEMENT to its desired length and the orientation of the padding characters to the left or right of the data. The default is space pad to the right.
.08 REQUIRED 0;8 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  DEC 07, 1995
  • HELP-PROMPT:  Enter 1 (YES) if this data element is on a local screen 9 form and the data is required for the bill to be authorized.
  • DESCRIPTION:  
    This field controls the required/not required status of a data element on a local screen 9 form. If this field is 1 (YES), this data element is always required to have data (not null) in order for a bill to be authorized.
.09 EDIT STATUS 0;9 SET
  • 'E' FOR EDITABLE;
  • 'D' FOR DISPLAY ONLY;

  • LAST EDITED:  MAR 20, 1996
  • HELP-PROMPT:  Enter 'E' to enable editing for this field, 'D' for a display only field.
  • DESCRIPTION:  
    This field is used to control whether or not a data element on a screen is editable or for display-only purposes.
.1 EDIT GROUP NUMBER 0;10 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAR 21, 1996
  • HELP-PROMPT:  Enter the edit group # that this field will be included in. Valid #'s are 1-99.
  • DESCRIPTION:  This field contains the # of the edit group that the screen data element will be included with. When this group # is selected on an edit screen, all data elements assigned to this group # on this screen will be presented
    for editing. If no # is entered here, this field will not be available for editing. This field will only apply to screen-type forms' editable data element descriptions.
1 FORMAT CODE 1;E1,245 MUMPS

  • INPUT TRANSFORM:  K:$L(X)>245 X D:$D(X) ^DIM
  • LAST EDITED:  DEC 07, 1995
  • HELP-PROMPT:  This is Standard MUMPS code.
  • DESCRIPTION:  This is the code that will be xecuted to format the 'raw' data element value that is returned from the execution of the DATA ELEMENT's definition. This code can assume the variable/array IBXDATA is available as input and
    should set this variable/array as its output. Standard calls for data formatting have been provided. The variables IBXPG, IBXLN, IBXCOL are the only IBX* variables that should be changed in this routine. These represent
    the page, line, column as the first 3 levels of subscript for the output array.
    WRITE AUTHORITY: @
3 FORMAT CODE DESCRIPTION 3;0 WORD-PROCESSING #364.73

  • LAST EDITED:  JUL 10, 1996
  • DESCRIPTION:  
    This field describes the function of the format code entered.
  • LAST EDITED:  JUL 10, 1996
  • HELP-PROMPT:  Enter a description of the processing logic of the format code.
  • DESCRIPTION:  
    This is a description of the processing logic of the format code.

Found Entries, Total: 1688

FORM FIELD REFERENCE: 364.6^1^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^4^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^6^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^7^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^3^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^9^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^10^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^11^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^12^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^13^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1015^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1016^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^17^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^16^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^18^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^22^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^26^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^27^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^28^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^60^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^61^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^92^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^56^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^59^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^76^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^75^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^42^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^139^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^86^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^85^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^87^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^93^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^29^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^31^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^30^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^32^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^140^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^67^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^47^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^141^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^81^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^82^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^58^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^945^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^38^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^35^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^36^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^37^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^33^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^34^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^39^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^40^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^41^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^43^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^64^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^44^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^45^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^46^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^48^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^66^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^83^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^84^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^49^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^50^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^51^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^52^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^53^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^54^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^159^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^156^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^155^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^153^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^152^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^151^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^150^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1029^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1030^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^147^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^146^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^145^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^144^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^70^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^73^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^71^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^72^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^142^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^55^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^143^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^57^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^62^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^63^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^91^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^88^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^161^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^89^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1031^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^74^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^95^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^96^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^97^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^98^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^100^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^99^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^162^IB 837 TRANSMISSION    
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FORM FIELD REFERENCE: 364.6^165^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^166^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^2465^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^192^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^65^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^190^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^189^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^133^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^134^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^137^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^135^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^136^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^138^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1032^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^178^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^181^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^179^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^180^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^183^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^2466^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^186^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^185^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^187^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^188^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^193^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^170^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^171^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^600^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^173^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^174^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^167^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^168^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^169^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^106^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^112^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^113^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^114^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^115^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^116^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^117^IB 837 TRANSMISSION    
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FORM FIELD REFERENCE: 364.6^195^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^125^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^197^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^198^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1034^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1035^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^175^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^196^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^1036^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1037^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1038^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^209^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^215^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^216^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^217^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1039^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^1041^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1042^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1043^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1044^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1045^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1046^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1047^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1048^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^206^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^207^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^210^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^212^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^213^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^214^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^230^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1051^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^226^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^227^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1056^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1057^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1058^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^240^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1059^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^242^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^243^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^244^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^245^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^246^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^249^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^250^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^251^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^252^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^253^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1060^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1061^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1062^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1063^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^489^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^490^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^576^LEGACY HCFA-1500    
FORM FIELD REFERENCE: 364.6^495^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^496^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^497^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^1065^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^498^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^499^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^500^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^501^LEGACY HCFA-1500    
FORM FIELD REFERENCE: 364.6^502^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^503^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^504^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^505^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^506^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^507^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^508^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^509^LEGACY HCFA-1500    
FORM FIELD REFERENCE: 364.6^510^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^511^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^512^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^513^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^514^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^515^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^516^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^517^LEGACY HCFA-1500    
FORM FIELD REFERENCE: 364.6^518^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^519^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^520^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^521^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^522^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^523^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^524^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^525^LEGACY HCFA-1500    
FORM FIELD REFERENCE: 364.6^526^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^527^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^528^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^529^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^530^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^531^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^532^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^533^LEGACY HCFA-1500    
FORM FIELD REFERENCE: 364.6^534^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^535^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^536^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^537^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^538^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^539^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^540^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^541^LEGACY HCFA-1500    
FORM FIELD REFERENCE: 364.6^542^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^546^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^543^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^544^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^548^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^547^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^549^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^550^LEGACY HCFA-1500    
FORM FIELD REFERENCE: 364.6^551^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^552^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^562^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^563^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^564^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^565^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^567^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^568^LEGACY HCFA-1500    
FORM FIELD REFERENCE: 364.6^569^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^584^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^585^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^570^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^571^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^1072^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^572^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^589^LEGACY HCFA-1500    
FORM FIELD REFERENCE: 364.6^590^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^591^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^573^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^574^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^1073^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1074^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^592^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^554^LEGACY HCFA-1500    
FORM FIELD REFERENCE: 364.6^555^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^556^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^557^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^558^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^559^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^560^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^561^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^593^LEGACY HCFA-1500    
FORM FIELD REFERENCE: 364.6^545^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^594^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^595^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^566^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^596^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^597^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^598^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^599^LEGACY HCFA-1500    
FORM FIELD REFERENCE: 364.6^601^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^602^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^603^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^604^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^1075^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1076^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1077^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1081^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^1082    FORM FIELD REFERENCE: 364.6^1083    FORM FIELD REFERENCE: 364.6^1085    FORM FIELD REFERENCE: 364.6^1086    FORM FIELD REFERENCE: 364.6^1087    FORM FIELD REFERENCE: 364.6^1088    FORM FIELD REFERENCE: 364.6^1089    FORM FIELD REFERENCE: 364.6^1090    
FORM FIELD REFERENCE: 364.6^1091    FORM FIELD REFERENCE: 364.6^1094^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1095^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1096^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1189^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1190^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1192^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1191^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^172^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1194^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1207^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1209^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1210^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1211^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1212^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1213^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^1219^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1220^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1221^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1222^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1223^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1224^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1225^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1226^IB 837 TRANSMISSION    
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FORM FIELD REFERENCE: 364.6^1237^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1238^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1239^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1240^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1241^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1245^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1218^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1277^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^1278^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1279^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1280^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1281^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1282^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1283^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1284^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1287^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^1288^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1289^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1290^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1291^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1292^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1293^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1294^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1295^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^1116^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1126^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1135^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1162^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^488^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^479^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^481^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^483^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^582^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^583^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^580^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^581^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^579^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^605^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^606^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^607^LEGACY HCFA-1500    
FORM FIELD REFERENCE: 364.6^608^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^1171^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^610^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^611^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^612^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^613^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^614^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^615^LEGACY UB-92    
FORM FIELD REFERENCE: 364.6^616^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^617^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^618^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^619^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^620^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^621^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^622^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^623^LEGACY UB-92    
FORM FIELD REFERENCE: 364.6^624^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^625^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^626^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^627^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^628^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^629^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^630^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^631^LEGACY UB-92    
FORM FIELD REFERENCE: 364.6^632^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^633^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^634^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^635^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^636^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^637^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^638^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^639^LEGACY UB-92    
FORM FIELD REFERENCE: 364.6^640^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^641^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^642^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^643^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^644^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^645^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^646^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^647^LEGACY UB-92    
FORM FIELD REFERENCE: 364.6^648^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^649^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^650^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^651^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^652^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^1180^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1300^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^655^LEGACY UB-92    
FORM FIELD REFERENCE: 364.6^656^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^1182^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^658^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^1107^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1113^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^661^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^1115^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1108^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^1111^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1110^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1112^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1118^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1119^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1121^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1123^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1120^IB 837 TRANSMISSION    
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FORM FIELD REFERENCE: 364.6^1177^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1179^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1172^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1183^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1185^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1187^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1184^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1186^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^1188^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^728^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^729^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^730^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^731^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^732^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^733^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^734^LEGACY UB-92    
FORM FIELD REFERENCE: 364.6^735^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^736^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^737^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^738^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^739^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^740^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^741^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^742^LEGACY UB-92    
FORM FIELD REFERENCE: 364.6^743^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^744^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^745^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^746^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^747^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^748^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^749^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^750^LEGACY UB-92    
FORM FIELD REFERENCE: 364.6^751^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^752^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^753^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^754^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^755^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^756^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^757^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^758^LEGACY UB-92    
FORM FIELD REFERENCE: 364.6^759^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^760^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^761^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^1181^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1106^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^765^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^1254^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1255^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^1256^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1257^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1258^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1259^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1247^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1249^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1251^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1244^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^1246^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1248^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1250^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1114^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1122^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^663^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^664^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^665^LEGACY UB-92    
FORM FIELD REFERENCE: 364.6^666^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^678^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^679^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^680^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^681^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^682^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^683^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^684^LEGACY UB-92    
FORM FIELD REFERENCE: 364.6^685^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^686^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^687^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^688^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^689^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^690^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^691^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^692^LEGACY UB-92    
FORM FIELD REFERENCE: 364.6^693^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^694^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^695^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^696^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^697^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^698^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^699^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^700^LEGACY UB-92    
FORM FIELD REFERENCE: 364.6^701^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^702^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^703^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^704^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^705^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^706^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^707^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^708^LEGACY UB-92    
FORM FIELD REFERENCE: 364.6^709^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^710^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^711^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^712^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^713^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^714^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^715^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^716^LEGACY UB-92    
FORM FIELD REFERENCE: 364.6^717^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^718^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^719^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^720^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^721^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^722^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^724^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^725^LEGACY UB-92    
FORM FIELD REFERENCE: 364.6^726^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^727^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^766^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^767^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^768^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^769^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^770^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^771^LEGACY UB-92    
FORM FIELD REFERENCE: 364.6^772^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^774^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^775^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^777^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^781^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^778^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^779^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^780^LEGACY HCFA-1500    
FORM FIELD REFERENCE: 364.6^782^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^784^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^785^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^943^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^788^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^789^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^790^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^791^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^807^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^808^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^864^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^793^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^885^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^886^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^809^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^816^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^827^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^839^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^853^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^817^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^828^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^840^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^854^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^887^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^888^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^890^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^841^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^818^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^829^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^855^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^848^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^856^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^892^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^810^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^866^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^865^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^867^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^878^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^879^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^880^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^881^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^907^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^882^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^811^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^812^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^819^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^820^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^821^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^822^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^823^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^825^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^826^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^830^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^831^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^832^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^833^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^834^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^835^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^836^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^837^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^838^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^842^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^843^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^844^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^847^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^849^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^850^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^851^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^924^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^845^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^846^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^857^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^893^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^858^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^897^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^898^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^902^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^903^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^904^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^905^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^906^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^899^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^901^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^894^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^895^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^900^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^896^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^923^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^862^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^852^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^863^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^783^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^936^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^938^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^948^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^950^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^794^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^804^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^805^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^806^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^941^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^942^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^946^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^949^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^937^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^947^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^939^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^944^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^935^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^951^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^952^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^859^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^860^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^861^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^953^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^954^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^955^LEGACY UB-92    FORM FIELD REFERENCE: 364.6^956^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^957^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^958^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^960^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^959^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^965^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^967^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^795^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^977^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^978^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^979^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^980^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^981^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^982^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^177^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^796^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^970^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^971^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^972^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^974^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^975^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^968^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^868^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^869^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^870^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^871^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^872^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^873^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^874^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^875^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^876^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^877^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^976^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^883^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^912^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^908^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^909^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^910^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^921^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^911^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^914^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^918^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^920^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^913^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^919^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^915^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^917^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^916^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^884^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^983^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^985^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^986^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^988^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^993^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^991^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^992^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^994^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^996^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^995^LEGACY HCFA-1500    
FORM FIELD REFERENCE: 364.6^999^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1000^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1001^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^1002^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1004^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1005^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1006^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1007^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^1008^LEGACY HCFA-1500    FORM FIELD REFERENCE: 364.6^1009^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1010^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1011^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1012^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1014^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1301^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1303^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^1305^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1306^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1309^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1310^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1304^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1084    FORM FIELD REFERENCE: 364.6^1311    FORM FIELD REFERENCE: 364.6^1312^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^1313^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1314    FORM FIELD REFERENCE: 364.6^1315^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1316^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1317^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^973^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1318^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1319^IB 837 TRANSMISSION    
FORM FIELD REFERENCE: 364.6^990^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1320^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1321^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1322^IB 837 TRANSMISSION    FORM FIELD REFERENCE: 364.6^1400^CMS-1500    FORM FIELD REFERENCE: 364.6^1401^CMS-1500    FORM FIELD REFERENCE: 364.6^1402^CMS-1500    FORM FIELD REFERENCE: 364.6^1403^CMS-1500    
FORM FIELD REFERENCE: 364.6^1404^CMS-1500    FORM FIELD REFERENCE: 364.6^1405^CMS-1500    FORM FIELD REFERENCE: 364.6^1406^CMS-1500    FORM FIELD REFERENCE: 364.6^1407^CMS-1500    FORM FIELD REFERENCE: 364.6^1408^CMS-1500    FORM FIELD REFERENCE: 364.6^1409^CMS-1500    FORM FIELD REFERENCE: 364.6^1410^CMS-1500    FORM FIELD REFERENCE: 364.6^1411^CMS-1500    
FORM FIELD REFERENCE: 364.6^1412^CMS-1500    FORM FIELD REFERENCE: 364.6^1413^CMS-1500    FORM FIELD REFERENCE: 364.6^1414^CMS-1500    FORM FIELD REFERENCE: 364.6^1415^CMS-1500    FORM FIELD REFERENCE: 364.6^1416^CMS-1500    FORM FIELD REFERENCE: 364.6^1417^CMS-1500    FORM FIELD REFERENCE: 364.6^1418^CMS-1500    FORM FIELD REFERENCE: 364.6^1419^CMS-1500    
FORM FIELD REFERENCE: 364.6^1420^CMS-1500    FORM FIELD REFERENCE: 364.6^1421^CMS-1500    FORM FIELD REFERENCE: 364.6^1422^CMS-1500    FORM FIELD REFERENCE: 364.6^1423^CMS-1500    FORM FIELD REFERENCE: 364.6^1424^CMS-1500    FORM FIELD REFERENCE: 364.6^1425^CMS-1500    FORM FIELD REFERENCE: 364.6^1426^CMS-1500    FORM FIELD REFERENCE: 364.6^1427^CMS-1500    
FORM FIELD REFERENCE: 364.6^1428^CMS-1500    FORM FIELD REFERENCE: 364.6^1429^CMS-1500    FORM FIELD REFERENCE: 364.6^1430^CMS-1500    FORM FIELD REFERENCE: 364.6^1431^CMS-1500    FORM FIELD REFERENCE: 364.6^1432^CMS-1500    FORM FIELD REFERENCE: 364.6^1433^CMS-1500    FORM FIELD REFERENCE: 364.6^1434^CMS-1500    FORM FIELD REFERENCE: 364.6^1435^CMS-1500    
FORM FIELD REFERENCE: 364.6^1436^CMS-1500    FORM FIELD REFERENCE: 364.6^1437^CMS-1500    FORM FIELD REFERENCE: 364.6^1438^CMS-1500    FORM FIELD REFERENCE: 364.6^1439^CMS-1500    FORM FIELD REFERENCE: 364.6^1440^CMS-1500    FORM FIELD REFERENCE: 364.6^1441^CMS-1500    FORM FIELD REFERENCE: 364.6^1442^CMS-1500    FORM FIELD REFERENCE: 364.6^1443^CMS-1500    
FORM FIELD REFERENCE: 364.6^1444    FORM FIELD REFERENCE: 364.6^1445^CMS-1500    FORM FIELD REFERENCE: 364.6^1446^CMS-1500    FORM FIELD REFERENCE: 364.6^1447^CMS-1500    FORM FIELD REFERENCE: 364.6^1448^CMS-1500    FORM FIELD REFERENCE: 364.6^1449^CMS-1500    FORM FIELD REFERENCE: 364.6^1450^CMS-1500    FORM FIELD REFERENCE: 364.6^1451^CMS-1500    
FORM FIELD REFERENCE: 364.6^1452^CMS-1500    FORM FIELD REFERENCE: 364.6^1453^CMS-1500    FORM FIELD REFERENCE: 364.6^1454^CMS-1500    FORM FIELD REFERENCE: 364.6^1455^CMS-1500    FORM FIELD REFERENCE: 364.6^1456^CMS-1500    FORM FIELD REFERENCE: 364.6^1457^CMS-1500    FORM FIELD REFERENCE: 364.6^1458^CMS-1500    FORM FIELD REFERENCE: 364.6^1459^CMS-1500    
FORM FIELD REFERENCE: 364.6^1460^CMS-1500    FORM FIELD REFERENCE: 364.6^1461^CMS-1500    FORM FIELD REFERENCE: 364.6^1462^CMS-1500    FORM FIELD REFERENCE: 364.6^1463^CMS-1500    FORM FIELD REFERENCE: 364.6^1464    FORM FIELD REFERENCE: 364.6^1465^CMS-1500    FORM FIELD REFERENCE: 364.6^1466^CMS-1500    FORM FIELD REFERENCE: 364.6^1467^CMS-1500    
FORM FIELD REFERENCE: 364.6^1468^CMS-1500    FORM FIELD REFERENCE: 364.6^1469^CMS-1500    FORM FIELD REFERENCE: 364.6^1470^CMS-1500    FORM FIELD REFERENCE: 364.6^1471^CMS-1500    FORM FIELD REFERENCE: 364.6^1472^CMS-1500    FORM FIELD REFERENCE: 364.6^1473^CMS-1500    FORM FIELD REFERENCE: 364.6^1474^CMS-1500    FORM FIELD REFERENCE: 364.6^1475^CMS-1500    
FORM FIELD REFERENCE: 364.6^1476^CMS-1500    FORM FIELD REFERENCE: 364.6^1477^CMS-1500    FORM FIELD REFERENCE: 364.6^1478^CMS-1500    FORM FIELD REFERENCE: 364.6^1479^CMS-1500    FORM FIELD REFERENCE: 364.6^1480^CMS-1500    FORM FIELD REFERENCE: 364.6^1481^CMS-1500    FORM FIELD REFERENCE: 364.6^1482^CMS-1500    FORM FIELD REFERENCE: 364.6^1483^CMS-1500    
FORM FIELD REFERENCE: 364.6^1484^CMS-1500    FORM FIELD REFERENCE: 364.6^1485^CMS-1500    FORM FIELD REFERENCE: 364.6^1486^CMS-1500    FORM FIELD REFERENCE: 364.6^1487^CMS-1500    FORM FIELD REFERENCE: 364.6^1488^CMS-1500    FORM FIELD REFERENCE: 364.6^1489^CMS-1500    FORM FIELD REFERENCE: 364.6^1490^CMS-1500    FORM FIELD REFERENCE: 364.6^1491^CMS-1500    
FORM FIELD REFERENCE: 364.6^1492^CMS-1500    FORM FIELD REFERENCE: 364.6^1493^CMS-1500    FORM FIELD REFERENCE: 364.6^1494^CMS-1500    FORM FIELD REFERENCE: 364.6^1495^CMS-1500    FORM FIELD REFERENCE: 364.6^1496^CMS-1500    FORM FIELD REFERENCE: 364.6^1497^CMS-1500    FORM FIELD REFERENCE: 364.6^1498^CMS-1500    FORM FIELD REFERENCE: 364.6^1499^CMS-1500    
FORM FIELD REFERENCE: 364.6^1500^CMS-1500    FORM FIELD REFERENCE: 364.6^1501^CMS-1500    FORM FIELD REFERENCE: 364.6^1502^CMS-1500    FORM FIELD REFERENCE: 364.6^1503^CMS-1500    FORM FIELD REFERENCE: 364.6^1504^CMS-1500    FORM FIELD REFERENCE: 364.6^1505^CMS-1500    FORM FIELD REFERENCE: 364.6^1506^CMS-1500    FORM FIELD REFERENCE: 364.6^1507^CMS-1500    
FORM FIELD REFERENCE: 364.6^1508^CMS-1500    FORM FIELD REFERENCE: 364.6^1509^CMS-1500    FORM FIELD REFERENCE: 364.6^1513^CMS-1500    FORM FIELD REFERENCE: 364.6^1514^CMS-1500    FORM FIELD REFERENCE: 364.6^1515^CMS-1500    FORM FIELD REFERENCE: 364.6^1516^CMS-1500    FORM FIELD REFERENCE: 364.6^1517^CMS-1500    FORM FIELD REFERENCE: 364.6^1518^CMS-1500    
FORM FIELD REFERENCE: 364.6^1519^CMS-1500    FORM FIELD REFERENCE: 364.6^1520^CMS-1500    FORM FIELD REFERENCE: 364.6^1550^UB-04    FORM FIELD REFERENCE: 364.6^1551^UB-04    FORM FIELD REFERENCE: 364.6^1552^UB-04    FORM FIELD REFERENCE: 364.6^1553^UB-04    FORM FIELD REFERENCE: 364.6^1554^UB-04    FORM FIELD REFERENCE: 364.6^1555^UB-04    
FORM FIELD REFERENCE: 364.6^1556^UB-04    FORM FIELD REFERENCE: 364.6^1557^UB-04    FORM FIELD REFERENCE: 364.6^1558^UB-04    FORM FIELD REFERENCE: 364.6^1559^UB-04    FORM FIELD REFERENCE: 364.6^1560^UB-04    FORM FIELD REFERENCE: 364.6^1561^UB-04    FORM FIELD REFERENCE: 364.6^1562^UB-04    FORM FIELD REFERENCE: 364.6^1563^UB-04    
FORM FIELD REFERENCE: 364.6^1564^UB-04    FORM FIELD REFERENCE: 364.6^1565^UB-04    FORM FIELD REFERENCE: 364.6^1566^UB-04    FORM FIELD REFERENCE: 364.6^1567^UB-04    FORM FIELD REFERENCE: 364.6^1568^UB-04    FORM FIELD REFERENCE: 364.6^1569^UB-04    FORM FIELD REFERENCE: 364.6^1570^UB-04    FORM FIELD REFERENCE: 364.6^1571^UB-04    
FORM FIELD REFERENCE: 364.6^1572^UB-04    FORM FIELD REFERENCE: 364.6^1573^UB-04    FORM FIELD REFERENCE: 364.6^1574^UB-04    FORM FIELD REFERENCE: 364.6^1575^UB-04    FORM FIELD REFERENCE: 364.6^1576^UB-04    FORM FIELD REFERENCE: 364.6^1577^UB-04    FORM FIELD REFERENCE: 364.6^1578^UB-04    FORM FIELD REFERENCE: 364.6^1579^UB-04    
FORM FIELD REFERENCE: 364.6^1580^UB-04    FORM FIELD REFERENCE: 364.6^1581^UB-04    FORM FIELD REFERENCE: 364.6^1582^UB-04    FORM FIELD REFERENCE: 364.6^1583^UB-04    FORM FIELD REFERENCE: 364.6^1584^UB-04    FORM FIELD REFERENCE: 364.6^1585^UB-04    FORM FIELD REFERENCE: 364.6^1586^UB-04    FORM FIELD REFERENCE: 364.6^1587^UB-04    
FORM FIELD REFERENCE: 364.6^1588^UB-04    FORM FIELD REFERENCE: 364.6^1589^UB-04    FORM FIELD REFERENCE: 364.6^1590^UB-04    FORM FIELD REFERENCE: 364.6^1591^UB-04    FORM FIELD REFERENCE: 364.6^1592^UB-04    FORM FIELD REFERENCE: 364.6^1593^UB-04    FORM FIELD REFERENCE: 364.6^1594^UB-04    FORM FIELD REFERENCE: 364.6^1595^UB-04    
For the entire list of entries see: Here
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