UB-04 (1578) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
6
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
42
LENGTH
40
SHORT DESCRIPTION
PATIENT ADDR. - STREET (FL-9A)
CALCULATE ONLY OR OUTPUT
OUTPUT
