| Name | Value |
|---|---|
| FORM FIELD REFERENCE | CMS-1500 |
| SECURITY LEVEL | NATIONAL,NO EDIT |
| DATA ELEMENT | N-CMS-1500 24J REND PROV ID BR |
| PAD CHARACTER | NO PAD REQUIRED |
| FORMAT CODE | N Z S Z=12 F S Z=$O(IBXDATA(Z)) Q:'Z D PG^IBCEF3(IBXDATA(Z),Z) |
| FORMAT CODE DESCRIPTION | If more than 6 service dates (12 lines) exists for the bill, this outputs the rest on additional bill pages. |