LEGACY HCFA-1500 (967) 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	31
LOCAL OVERRIDE ALLOWED	YES
STARTING COLUMN OR PIECE	36
LENGTH	13
SHORT DESCRIPTION	PATIENT SIGNATURE DT (BX-12/2)