| Name | Value |
|---|---|
| FORM FIELD REFERENCE | UB-04 |
| SECURITY LEVEL | NATIONAL,NO EDIT |
| DATA ELEMENT | N-GET FROM PREVIOUS EXTRACT |
| PAD CHARACTER | NO PAD REQUIRED |
| FORMAT CODE | D REMARK^IBCEF77(IBXIEN,.IBXDATA,1) |
| FORMAT CODE DESCRIPTION | Remarks in FL-80 on the UB-04. All data is retrieved and formatted by REMARK^IBCEF77. Line 1 of this box has a mandatory 5 leading spaces and therefore only 19 printed characters can be in line 1. Lines 2-4 have a max length of 24 characters. |