LEGACY HCFA-1500 (1009)    IB FORM FIELD CONTENT (364.7)

Name Value
FORM FIELD REFERENCE LEGACY HCFA-1500
SECURITY LEVEL NATIONAL,NO EDIT
DATA ELEMENT N-LAB OR FACILITY PRIMARY ID
PAD CHARACTER NO PAD REQUIRED
FORMAT CODE D BOX324^IBCEP8A(IBXIEN,.IBXSAVE,.IBXDATA)
FORMAT CODE DESCRIPTION
HCFA-1500 form, Box 32, Line 4.
Display mammography certification number if it exists.
Otherwise, display the facility tax ID for remote VA site or non-VA site.