Product Overview
Approved by CMS, NUCC and OMB. Printed in OCR Red for scanning. 2-part continuous format. White/white paper sequence for 2-part continuous format. Continuous form works with most dot matrix/pin-feed printers and typewriters. Detached size: 8-1/2" W x 11" H. Version (02/12) for use beginning January 6, 2014.
