| Name | Value |
|---|---|
| NAME | DIAGNOSIS |
| FORM | DEFAULTS |
| BLOCK'S STARTING ROW | 115 |
| BLOCK'S STARTING COLUMN | 0 |
| WIDTH IN CHARACTERS | 132 |
| HEIGHT IN LINES | 15 |
| OUTLINE TYPE | SOLID LINE |
| BLOCK HEADER | PLEASE CHECK OFF DIAGNOSIS TREATED THIS VISIT |
| HEADER APPEARANCE | CR |
| BRIEF DESCRIPTION | Diagnosis codes |