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)
