Insert Selected Option into the Claims Reporting Form and eSign it in minutes

Aug 6th, 2022
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How to Insert Selected Option into the Claims Reporting Form

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hello everyone my name is khanam and this is my 10th video in php crutch series in our previous video we have seen how to add radio buttons data inside the database how to read that data and also how to update and delete the data now in this tutorial we are going to see how to insert select options data inside the database and then in later tutorial we will see how to update this project okay here i am going to create one new file i will give my file name as select.php php and inside this file ill just come to radiodata.php and from here im just going to copy this css link ill just copy this bootstrap css link and here inside my um select.php ill be creating first ill just create html boilerplate and here ill be pasting that css link okay now here ill just create one diff and for this div ill just give the class name as container and inside this dip i am going to create this selector select name i will just give here place id let me id let me remove as of now inside this i am g

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Item 9a - Enter the policy and/or group number of the Medigap insured preceded by MEDIGAP, MG, or MGAP. NOTE: Item 9d must be completed, even when the provider enters a policy and/or group number in item 9a. Item 9b - Form version 08/05: Enter the Medigap insureds 8-digit birth date (MM | DD | CCYY) and sex.
Box 17a. The Other ID number of the referring, ordering, or supervising provider is reported in 17a in the shaded area. The qualifier indicating what the number represents is reported in the qualifier field to the immediate right of 17a.
The street address, area, state, ZIP code, and telephone number are included. Box 11: This field requires the insureds policy or group number to be filled.
A Place of Service (POS) is a field used when completing a CMS 1500 form to submit a claim to insurance. It indicates the location in which the health care service is actually provided.
CMS 1500 Sample Claim Form and Instructions Type of health insurance coverage applicable to this claim check appropriate box. Patients Name. Patients Birth Date/Sex. Insureds Name (Same or leaving blank is not acceptable.) Patients Address. Patients Relationship to Insured.
9. Name of the INSURED PERSON of other payer in Insurance Information screen under Patient Master.
Box 23 is used to show the payer assigned number authorizing the service(s).
Box 9 indicates that there is another policy that may cover the patient. The insureds name is entered as Last Name, First Name, Middle Initial, separated by commas.

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