The CMS-1500 form is divided into two major sections, the top portion of the CMS-1500 has 13 form locators 11 data elements and two signature locators. The bottom portion has 20 locators with 19 data elements and on signature locator.

1-13: Patient and insured information

1- type of insurance
1a- insured ID number
2-patients name
3-patients DOB and sex
4-insureds name
5-patients address
6-patients relationship to the insured
7-insurers address
8-patients status
9-other insureds name
9a-other insureds policy or group number
9b-other insurers dob/sex
9c-employers name or school name
9d-insurance plan, name or program
10a-c: is patient condition related to?
10d-reserved for local use
11-insurers policy number or FECA number
11a-insured