LEGACY HCFA-1500 (502) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
LEGACY HCFA-1500
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
13
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
33
LENGTH
1
SHORT DESCRIPTION
PT REL TO INSURED=SELF (BX-6)
