HCFA AUDIT RULES (Field 12)

Forms must be keyed in all CAPITAL LETTERS.
  
“Key what you see” means to literally key what you see. You are trying to replicate the form as it was submitted; you cannot fix errors.

H12_Signature

Only allowed value: S (or leave blank)

If signed or if SIGNATURE ON FILE, enter S. If blank or verbiage to indicate that it has not been signed, leave blank.

H12_Signature : Examples:

As it appears on form:	As it should be keyed:
JOHN SMITH	S
SIGNATURE ON FILE	S
SOF	S

H12_Date

Hyphens, spaces, periods and slashes are optional. If the year is four digits, set four digits. If the year is two digits, set two digits. If the month or day is NOT two digits, either add a zero to make it two digits or add hyphens, spaces, periods or slashes. Date fields should NOT contain alphabetic characters. If a date is spelled out (e.g., May 1, 1984), change it to numbers. If any text appears in the field (e.g., STILL IN), do NOT key.

H12_Date : Examples;

As it appears on form:	Acceptable entries:
02/04/1972	02/04/1972	02-04-1972	02 04 1972	02.04.1972	02041972
1 08 69	1/08/69	1-08-69	1 08 69	1.08.69	010869
May 1, 1984	5/1/1984	5-1-1984	5 1 1984	5.1.1984	05011984