Patient Information Data Fields in Form and Label Templates
The following table lists the Data Repository data fields for Patient Information.
| Data Fields | Description |
|---|---|
| Alternate Phone | Patient's alternate phone number
|
| Alternate Phone Ext. | Patient's alternate phone extension number
|
| *Birth Date | Date of birth (mandatory) |
| *Birth Date(mmddyy) | Date of birth in the mmddyy format |
| Chart Details Marketing Co... | Chart Details Marketing Comments |
| Chart Details Marketing Data | Chart Details Marketing Data |
| Chart Details Marketing Plan | Chart Details Marketing Plan |
| Correspondence Language | Patient's preferred correspondence language |
| Day Phone | Patient's daytime phone number
|
| Day Phone Ext. | Patient's daytime phone extension number
|
| Email Address | Email address of the patient |
| Ethnicity | Ethnicity is a multi-value field.
|
| External ID | This data field pulls the ID from the External ID field on the Ext tab in the Add/Modify Patient Information window. |
| Female X-Mark | Female X-Mark |
| Gender Identity | Gender identity
|
| Head of Household Name | Name of the head of the household. |
| Home Phone | Patient's home phone number
|
| Male X-Mark | Male X-Mark |
| Marital Status | Marital status of the patient |
| Other ID Number | Other ID number
|
| Patient Age (yrs mos) | Patient's age in the years months format |
| Patient Age (yrs) | Patient age in years |
| Patient City | Patient's city |
| Patient City, State Zip | Patient city name and state zip code |
| Patient First Last Name | Patient name displays in the First Last format. For example, John Doe
|
| Patient First Name | Patient's first name |
| Patient Full Name | Patient full name The patient name appears in the Last, First Middle. For example, Doe, John Lee for a patient with the name John Lee Doe. |
| Patient Full Name With Prefix/Suffix | Patient's full name with prefix-such as Mr. , and suffix-such as Jr. |
| Patient Last Name | Patient's last name |
| Patient Medical Record # | Patient's medical record number |
| *Patient Medical Record #(… | Patient medical record number with barcode (mandatory) |
| *Patient Medical Record #(… | Patient medical record number with document management barcode (mandatory) |
| *Patient Medical Record # (… | Patient medical record number with leading zeros (mandatory) |
| Patient Middle Name | Patient middle name |
| Patient PCP | Patient primary care provider |
| Patient Picture | Patient picture |
| Patient Privacy Notice Issued | Privacy notice issued to patient |
| Patient Privacy Notice Note | Privacy notice note added to the patient |
| Patient Privacy Notice Retu... | Privacy notice returned to patient |
| Patient Privacy Signature R... | Patient privacy signature reason |
| Patient Secondary Address 1 | Patient Secondary Address 1 |
| Patient Secondary Address 2 | Patient Secondary Address 2 |
| Patient Secondary City | Patient Secondary City |
| Patient Secondary City, Stat... | Patient Secondary City, State Zip |
| Patient Secondary State | Patient Secondary State |
| Patient Secondary Zip | Patient Secondary Zip |
| Patient State | Patient State |
| Patient Status | Patient status as set in the chart |
| Patient Status Reason Cha… | Patient status reason change |
| Patient Street Address 1 | Patient Street Address 1 |
| Patient Street Address 2 | Patient Street Address 2 |
| Patient Work Phone | Patient Work Phone |
| Patient Zip | Patient Zip |
| PCP Prov Address 1 | PCP Prov Address 1 |
| PCP Prov Address 2 | PCP Prov Address 2 |
| PCP Prov City | PCP Prov City |
| PCP Prov Other 1 Phone | PCP Prov Other 1 Phone |
| PCP Prov Phone | PCP Prov Phone |
| PCP Prov State | PCP Prov State |
| PCP Prov Zip | PCP Prov Zip |
| Person Number | Person Number
|
| Person Number (Doc Mgmt Advanced) | Person Number (Doc Mgmt Advanced) |
| Person Number (Doc Mgmt Separator) | Person Number (Doc Mgmt Separator) |
| Pharmacy Address 1 | Pharmacy Address 1 |
| Pharmacy Address 2 | Pharmacy Address 2 |
| Pharmacy city | Pharmacy city |
| Pharmacy Fax | Pharmacy Fax |
| Pharmacy Name | Pharmacy Name The maximum number of characters allowed is 70. |
| Pharmacy Note | Pharmacy Note |
| Pharmacy phone | Pharmacy phone |
| Pharmacy state | Pharmacy state |
| Pharmacy zip | Pharmacy zip |
| PostOp 1-10 | Post-op date These fields print up to 10 procedures that have post-op periods. The records are printed for charges that have After Care Days specified on tab and have a last date of post-op later than or equal to today's date. The last date of post-op is calculated by adding the number of After Care Days to the service date. The data prints in the format SIM - SIM Description - Date of last day of post op period. For example 67210L - Focal Laser Left Eye - 2/1/2009. A code does not appear if the calculated date is earlier than the current day or the number of aftercare days is not greater than zero. |
| Poverty Category | Poverty category, which accompanies the poverty percentage, as defined in the Patient Responsibility master file |
| Poverty Percent | Poverty percentage as defined in the Patient Responsibility master file based on the patient's family size and income. |
| Preferred Pronoun | Preferred pronoun |
| Primary Care Physician | Patient's primary care physician |
| Primary Dental PCP | Patient's primary care physician for dental care |
| Secondary Hm Phn | Patient's secondary home phone number.
|
| Sex | Patient's gender |
| Sexual Orientation | Sexual orientation
|
| SSN | Social Security Number |
| Patient Provider User-Defined Field 1-12 | These fields print up to 12 user defined fields.
|
| Support Role Descr 1 | Support Role Descr 1 |
| Support Role Descr 2 | Support Role Descr 2 |
| Support Role Descr 3 | Support Role Descr 3 |
| Support Role Name 1 | Support Role Name 1 |
| Support Role Name 2 | Support Role Name 2 |
| Support Role Name 3 | Support Role Name 3 |
| Chart User-Defined Field 1-8 | These fields use the names set up on the Chart Practice Preferences. The data pulls from the user-defined fields on the Chart Details dialog box. |
| Client Defined Field 1-14 | These fields print up to 14 client-defined fields
|
| Race | This field pulls the race from the Race field on either the Demographics or UDS tab of the Add/Modify Patient Information dialog box. |
| Preferred Language | Preferred language
|
| Religion | Religion
|
| Church | Church
|
| Responsible Party Information | |
| Client Defined Fields (11-14) | Client defined fields (11-14) |
| Chart Guarantor Address 1 | Chart guarantor address 1 |
| Chart Guarantor Address 2 | Chart guarantor address 2 |
| Chart Guarantor City, State Zip | Chart guarantor city, state, and zip code |
| Chart Guarantor Day Phone | Chart guarantor day phone |
| Chart Guarantor DOB | Chart guarantor date of birth |
| Chart Guarantor Email | Chart guarantor email |
| Chart Guarantor Full Name | Chart guarantor full name |
| Chart Guarantor Home Phone | Chart guarantor home phone |
| Chart Guarantor Marital Status | Chart guarantor marital status |
| Chart Guarantor PCP | Chart guarantor primary care provider |
| Chart Guarantor Preferred Language | Chart guarantor preferred language |
| Chart Guarantor Relationship | Chart guarantor relationship |
| Chart Guarantor Sec Address 1 | Chart guarantor secondary address 1 |
| Chart Guarantor Sec Address 2 | Chart guarantor secondary address 2 |
| Chart Guarantor Sec City, State Zip | Chart guarantor secondary city, state, and zip code |
| Chart Guarantor Sec Home Phone | Chart guarantor secondary home phone |
| Chart Guarantor Sex | Chart guarantor gender |
| Chart Guarantor Smoker(Y/N) | Chart guarantor smoker preference (Y/N) |
| Chart Guarantor SSN | Chart guarantor social security number |
| Chart Guarantor Student Status | Chart guarantor student status |
| Chart Guarantor Veteran(Y/N) | Chart guarantor veteran (Y/N) |
| Data Fields | Description |
|---|---|
| Primary Insurance | |
| Patient Primary City | Patient primary city |
| Patient Primary City, State... | Patient primary city, state, and zip code |
| Patient Primary Contact F... | Patient primary contact full name |
| Patient Primary Copay Am... | Patient primary copay amount |
| Patient Primary Group # | Patient primary group number |
| Patient Primary Group Na... | Patient primary group name |
| Patient Primary Ins Conta... | Patient primary insured contact fax number |
| Patient Primary Ins Conta... | Patient primary insurance contact phone |
| Patient Primary Insured A... | Patient primary insured address line 1 |
| Patient Primary Insured A... | Patient primary insured address line 2 |
| Patient Primary Insured City | Patient primary insured city |
| Patient Primary Insured C... | Patient primary insured country |
| Patient Primary Insured C... | Patient primary insured county |
| Patient Primary Insured D... | Patient primary insured date of birth |
| Patient Primary Insured E... | Patient primary insured employer |
| Patient Primary Insured N... | Patient primary insured name |
| Patient Primary Insured O... | Patient primary insured occupation |
| Patient Primary Insured R... | Patient primary insured relationship to patient |
| Patient Primary Insure Sex | Patient primary insured gender |
| Patient Primary Insured S... | Patient primary insured social security number |
| Patient Primary Insured St... | Patient primary insured state |
| Patient Primary Insured... | Patient primary insured work phone |
| Patient Primary Insured Zip | Patient primary insured zip code |
| Patient Primary Name | Patient primary name |
| Patient Primary Plan # | Patient primary plan number |
| Patient Primary Policy # | Patient primary policy number |
| Patient Primary State | Patient primary state |
| Patient Primary Street Ad... | Patient primary street address 1 |
| Patient Primary Street Ad... | Patient primary street address 2 |
| Patient Primary Zip | Patient primary zip |
| Payer User-Defined 1 Na... | Payer user-defined 1 name |
| Secondary Insurance | |
| Patient Secondary City | Patient secondary city |
| Patient Secondary City, S... | Patient secondary city, state, and zip code |
| Patient Secondary Conta... | Patient secondary contact full name |
| Patient Secondary Copay... | Patient secondary copay amount |
| Patient Secondary Group # | Patient secondary group number |
| Patient Secondary Group... | Patient secondary group name |
| Patient Secondary Ins Co... | Patient secondary insured contact fax |
| Patient Secondary Ins Co... | Patient secondary insured contact phone number |
| Patient Secondary Insure... | Patient secondary insured address line 1 |
| Patient Secondary Insure... | Patient secondary insured address line 2 |
| Patient Secondary Insure... | Patient secondary insured city |
| Patient Secondary Insure... | Patient secondary insured country |
| Patient Secondary Insure... | Patient secondary insured county |
| Patient Secondary Insure... | Patient secondary insured date of birth |
| Patient Secondary Insured... | Patient secondary insured employer |
| Patient Secondary Insure... | Patient secondary insured name |
| Patient Secondary Insure... | Patient secondary insured occupation |
| Patient Secondary Insure... | Patient secondary insured relationship to patient |
| Patient Secondary Insure... | Patient secondary insured gender |
| Patient Secondary Insure... | Patient secondary insured social security number |
| Patient Secondary Insure... | Patient secondary insured state |
| Patient Secondary Insure... | Patient secondary insured work phone |
| Patient Secondary Insure... | Patient secondary insured zip |
| Patient Secondary Name | Patient secondary name |
| Patient Secondary Plan # | Patient secondary plan number |
| Patient Secondary Policy # | Patient secondary policy number |
| Patient Secondary State | Patient secondary state |
| Patient Secondary Street... | Patient secondary street address 1 |
| Patient Secondary Street... | Patient secondary street address 2 |
| Patient Secondary Zip | Patient secondary zip |
| Tertiary Insurance | |
| Patient Tertiary Contact F... | Patient tertiary contact full name |
| Patient Tertiary Insured A... | Patient tertiary insured address line 1 |
| Patient Tertiary Insured A... | Patient tertiary insured address line 2 |
| Patient Tertiary Insured City | Patient tertiary insured city |
| Patient Tertiary Insured C... | Patient tertiary insured country |
| Patient Tertiary Insured C... | Patient tertiary insured county |
| Patient Tertiary Insured D... | Patient tertiary insured date of birth |
| Patient Tertiary Insured E... | Patient tertiary insured employer |
| Patient Tertiary Insured N... | Patient tertiary insured name |
| Patient Tertiary Insured O... | Patient tertiary insured occupation |
| Patient Tertiary Insured R... | Patient tertiary insured relationship to patient |
| Patient Tertiary Insure Sex | Patient tertiary insured sex |
| Patient Tertiary Insured S... | Patient tertiary insured social security number |
| Patient Tertiary Insured S... | Patient tertiary insured state |
| Patient Tertiary Insured... | Patient tertiary insured work phone |
| Patient Tertiary Insured Zip | Patient tertiary insured zip |