Confidential Screening/Billing Report (PM 160) Claim Form ...
If the patient’s ethnicity is not included in the code list on the PM 160, or if ethnicity is unknown, enter code 7 (Other). See the Appendix in this manual for the Asian and Pacific Islander Groups Reported in the 1980 Census chart. The chart differentiates Pacific Islanders from other Asian groups. Date of Service DATE OF SERVICE. ................
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