Abstract: An insurance form carries first pattern areas into which data representing identify of an insurance claimant and identity of a health insurance company against which a claim form is entered and second pattern areas in which symbols are entered representing a state abbreviation, a congressional district of the state, a city of the congressional district, physician's classification as listed in a State Medical Directory, a number representing the total number of particular physicians in the physician's classification designation, a patient number which changes with every claim filed and an identification number of a health insurance company against whom the claim is filed.