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