N-HCFA 1500 BOX 12 (145)    IB DATA ELEMENT DEFINITION (364.5)

Name Value
NAME N-HCFA 1500 BOX 12
SECURITY LEVEL NATIONAL,NO EDIT
TYPE OF ELEMENT CONSTANT VALUE
ELEMENT CATEGORY INDIVIDUAL ELEMENT
BASE FILE BILL/CLAIMS
CONSTANT VALUE SIGNATURE ON FILE
DESCRIPTION
PATIENT'S OR AUTHORIZED SIGNATURE FOR RELEASE OF INFORMATION TEXT