"Block 17: Name of Referring Provider or Other Source:
If multiple providers are involved, enter one provider using the following priority order: 1. Referring provider 2. Ordering provider 3. Supervising provider
Do not use periods or commas within the name. A hyphen can be used for hyphenated names.
Enter the applicable qualifier to the left of the vertical, dotted lines to identify which provider is being reported. DN Referring provider DK Ordering provider DQ Supervising provider"
When filling out Block 17 of a CMS-1500 form, which qualifier should be used to identify the referring provider?
a) DN
b) DK
c) DQ
d) DR