CMS-1500 (1155)    IB FORM FIELD CONTENT (364.7)

Name Value
FORM FIELD REFERENCE CMS-1500
SECURITY LEVEL NATIONAL,NO EDIT
DATA ELEMENT N-PATIENT NAME
PAD CHARACTER NO PAD REQUIRED
FORMAT CODE N Z S Z=$$NAME^IBCEFG1(IBXDATA),IBXDATA=$P(Z,U,2)_" "_$S($P(Z,U,3)'="":$E($P(Z,U,3))_" ",1:"")_$P(Z,U)
FORMAT CODE DESCRIPTION
Output the patient's name as the signature first middle last name.