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1 4 3a PAT. CNT # b. MED. REC. # 2 6 5 FED. TAX NO. 8 PATIENT NAME 9 PATIENT ADDRESS a 10 BIRTHDATE 11 SEX 31 OCCURRENCE CODE DATE 12 DATE a c ADMISSION 13 HR 14 TYPE 15 SRC 16 DHR 17 STAT 32 OCCURRENCE

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What is cyan indicates situational fields?

Cyan indicates situational fields are specific areas on a form or document that require additional information based on certain circumstances.

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Anyone filling out a form or document that contains cyan indicates situational fields is required to provide the necessary information.

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The information required on cyan indicates situational fields will vary depending on the specific circumstances outlined in the form or document.

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