UB-04 (1608)    IB FORM SKELETON DEFINITION (364.6)

Name Value
BILL FORM UB-04
SECURITY LEVEL NATIONAL,NO EDIT
PAGE OR SEQUENCE 1
FIRST LINE NUMBER 9
LOCAL OVERRIDE ALLOWED YES
STARTING COLUMN OR PIECE 25
LENGTH 1
SHORT DESCRIPTION ADMISSION SOURCE (FL-15)
CALCULATE ONLY OR OUTPUT OUTPUT