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)