LEGACY HCFA-1500 (998) IB FORM FIELD CONTENT (364.7)
Name
Value
FORM FIELD REFERENCE
LEGACY HCFA-1500
SECURITY LEVEL
NATIONAL,NO EDIT
DATA ELEMENT
N-HCFA 1500 BOX 12
PAD CHARACTER
NO PAD REQUIRED
FORMAT CODE
N IBZ D F^
IBCEF
("N-ROI INDICATOR","IBZ") I IBZ S IBXDATA="MODIFIED/RESTRICTED RELEASE "_IBXDATA