NATL COVID19 SPLMNTL FY21-Q3 (903)    ENCOUNTER FORM (357)

Name Value
NAME NATL COVID19 SPLMNTL FY21-Q3
SIMPLEX/DUPLEX SIMPLEX
BRIEF DESCRIPTION National COVID-19 ICD Supplemental Form April 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