LEGACY HCFA-1500 (484)    IB FORM FIELD CONTENT (364.7)

Name Value
FORM FIELD REFERENCE LEGACY HCFA-1500
SECURITY LEVEL NATIONAL,NO EDIT
DATA ELEMENT N-HCFA EMERGENCY INDICATOR
PAD CHARACTER NO PAD REQUIRED
FORMAT CODE N Z,Z0,IBZ M IBZ=IBXDATA K IBXDATA S Z=0 F S Z=$O(IBZ(Z)) Q:'Z S Z0=$S('$G(IBZ(Z,"T")):$S(IBZ(Z)="Y":" Y",1:""),1:IBZ(Z)) S:Z'>12 IBXDATA(Z)=Z0 D:Z>12 PG^IBCEF3(Z0,Z)
FORMAT CODE DESCRIPTION
Print a space before the 'Y' if an emergency procedure is indicated.
If more than 6 service dates (12 lines) exists for the bill, this outputs
the rest on additional bill pages.