Field 16 - Dates Patient Unable to Work in Current Occupation

“Dates Patient Unable to Work in Current Occupation” is the time span the patient is or was unable to work.
NUCC INSTRUCTIONS: If the patient is employed and is unable to work in current occupation, a 6-digit (MM│DD│YY) or 8-digit (MM│DD│YYYY) date must be shown for the “from–to” dates that the patient is unable to work. An entry in this field may indicate employment-related insurance coverage.
MEDICARE INSTRUCTIONS - If the patient is employed and is unable to work in his/her current occupation, enter an 8-digit (MM | DD | CCYY) or 6-digit (MM | DD | YY) date when patient is unable to work. An entry in this field may indicate employment related insurance coverage.
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Field 2 - Patient's Name
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Field 3 - Patient's Birth Date
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Field 12 - Patient’s or Authorized Person’s Signature
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FIELD 26- Patient’s Account No.
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