If the patient is claiming insurance cover, this is HAAD’s insurance license number If the patient is claiming insurance from an insurance not licensed by HAAD, this should be “@” followed by the name of the Insurance If the patient is paying directly for services provided, this should be “SelfPay” If the patient neither claims insurance nor pays directly for services provided, this should be “ProFormaPayer” Example | H018 Example | @Cigna Medical Example | SelfPay Example | ProFormaPayer.

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