UB-04 (1580) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
7
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
65
LENGTH
2
SHORT DESCRIPTION
PATIENT ADDR. - STATE (FL-9C)
CALCULATE ONLY OR OUTPUT
OUTPUT
