The CMS tab (figure 9) includes additional information that is required for the completion of the CMS-1500 claim form. Some of this information is required while some of it is optional.
Figure 9
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Symptoms Box
Disability Box
Reserved for Local Use (Box 19)
Hospitalization (Box 18) Box
Condition Related To Box
Box 10d Reserved For Local Use Box
Referring Physician (Box 17 and 17A)
