Printing A CMS 1500 Form

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To print data on a CMS-1500 form first initialize the fields to be printed in the CMSFormData class then print them using the CMS1500Form class.

Step 1 – Initialize Fields To Print

CMSFormData cmsData = new CMSFormData();

cmsData.BoxHeader = “All Practice” + Environment.NewLine + “New York”;

cmsData.Box1A = true;

cmsData.Box1Aa = “Insured ID Number”;

cmsData.Box2 = “Jane Doe”;

cmsData.Box3A = DateTime.Today;

cmsData.Box3C = true;

cmsData.Box4 = “Same As Patient”;

cmsData.Box5A = “123 Washington Avenue”;

cmsData.Box5B = “SpringField”;

cmsData.Box5C = “IL”;

cmsData.Box5D = “12345”;

cmsData.Box5E = “2122323321”;

cmsData.Box6A = true;

cmsData.Box7A = “Same”;

cmsData.Box10Ab = true;

cmsData.Box10Bb = true;

cmsData.Box10Cb = true;

cmsData.Box11 = “99999”;

cmsData.Box11A = DateTime.Today;

cmsData.Box11Ac = true;

cmsData.Box11Db = true;

cmsData.Box12A = “PATIENT SIGNATURE ON FILE”;

cmsData.Box13 = “SINGATURE ON FILE”;

cmsData.Box14A = DateTime.Today;

cmsData.Box15B = DateTime.Today;

cmsData.Box16A = DateTime.Today;

cmsData.Box16B = DateTime.Today;

cmsData.Box17 = “Doctor Smith”;

cmsData.Box17B = “12345”;

cmsData.Box18A = DateTime.Today;

cmsData.Box18B = DateTime.Today;

cmsData.Box20Aa = true;

cmsData.Box20B = 12342;

cmsData.Box21A = “90210”;

cmsData.Box21B = “90211”;

cmsData.Box21C = “90212”;

cmsData.Box21D = “90213”;

cmsData.Box23 = “None”;

cmsData.Box25A = “123-12-3334”;

cmsData.Box25C = true;

cmsData.Box26 = “9383333”;

cmsData.Box27A = true;

cmsData.Box28 = 1024;

cmsData.Box29 = 456;

cmsData.Box30 = null;

cmsData.Box32 = “742 Evergreen Terrace” + Environment.NewLine + “Springfield IL 9999”;

cmsData.Box32A = “99999”;

cmsData.Box33 = “Joe Doe Therapy” + Environment.NewLine + “Springfield IL 9999”;

cmsData.Box33A = “99999”;

cmsData.Box33C = “1233233333”;

//Service lines

Box24 box24 = new Box24();

box24.Box24Aa = DateTime.Today;

box24.Box24Ab = DateTime.Today;

box24.Box24B = “11”;

box24.Box24D = “99990”;

box24.Box24Mod1 = “10”;

box24.Box24E = “1”;

box24.Box24F = 125;

box24.Box24G = “1”;

cmsData.Box24.Add(box24);

Step 2 – Print the Field

CMS1500Form cmsForm = new CMS1500Form();

cmsForm.Data.Add(cmsData);

cmsForm.Print();

Please make sure that CMS-1500 forms are in the printer before calling the Print() method

Sample Output

Note that the printing offsets may need to be slightly adjusted in the sample below. See the Setting Printing Offsets topic.

Last Updated: 4 years ago in CMS – 1500 Form

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Printing A CMS 1500 Form

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