UB-04 (1703) IB FORM SKELETON DEFINITION (364.6)

Name	Value
BILL FORM	UB-04
SECURITY LEVEL	NATIONAL,NO EDIT
PAGE OR SEQUENCE	1
FIRST LINE NUMBER	19
LOCAL OVERRIDE ALLOWED	YES
STARTING COLUMN OR PIECE	.8
SHORT DESCRIPTION	PROCEDURE EXTRACT
CALCULATE ONLY OR OUTPUT	CALCULATE ONLY