| Name | Value |
|---|---|
| NAME | NATL COVID19 SPLMNTL FY22-Q1 |
| SIMPLEX/DUPLEX | SIMPLEX |
| BRIEF DESCRIPTION | National COVID-19 ICD Supplemental Form October 2021 |
| TYPE OF USE | OUTPATIENT ENCOUNTER FORM |
| COMPILED? | NO |
| USE ICR? | NO |
| TOOLKIT | YES |
| RIGHT MARGIN | 133 |
| PAGE LENGTH | 80 |
| NUMBER OF PAGES | 1 |
| SCANNED/MANUAL DATA ENTRY | YES |
| PAPER SIZE | LETTER (8 1/2 x 11) |
| ORIENTATION | PORTRAIT |
| TEXT SIZE | 133 COLUMNS x 80 LINES |
| VERSION | 2.1 |