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
