LEGACY HCFA-1500 (791)    IB FORM FIELD CONTENT (364.7)

Name Value
FORM FIELD REFERENCE LEGACY HCFA-1500
SECURITY LEVEL NATIONAL,NO EDIT
DATA ELEMENT N-CURR INSURED FULL ADDRESS
PAD CHARACTER NO PAD REQUIRED
FORMAT CODE I '$G(IBXSAVE("IBSAME")) S IBXSAVE("IADR")=IBXDATA