UB-04 (1649)    IB FORM SKELETON DEFINITION (364.6)

Name Value
BILL FORM UB-04
SECURITY LEVEL NATIONAL,NO EDIT
PAGE OR SEQUENCE 1
FIRST LINE NUMBER 54
LOCAL OVERRIDE ALLOWED YES
STARTING COLUMN OR PIECE 34
LENGTH 7
SHORT DESCRIPTION OTHER DIAG CODE 4 (FL-67D/1/1)