form / prompts.txt
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Main Field Sub Field
0c20164 verified
Main Field Sub Field
Personal
General Info
Patient ID Dropdown Data Fields
Last Name
First Name
Middle Name
Preferred Name
Suffix
Birthdate
Account Number
Customer Type
Facility Master
Facility Resident
Patient
Prior System Key
Facility Search Field
Billing Address
Address
Address
City
State
County
Country
Postal Code
_____-____
Custom Fields
S&S and Elig and Deduct
Incont Campaign
Successful
Unsuccessful
Compress Campaign
Successful
Unsuccessful
Mailer - Incont Campaign
Successful
Unsuccessful
Clamp On Rail Campaign
Successful
Unsuccessful
BP Machines Campaign
Successful
Unsuccessful
Extended Info
Hold Account
Hold Billing Statements
HIPAA Signature on file
Discount Percent %
Tax Zone
Search Field
Branch Office
New Hampshire Medical Supply
NHMS BRA
NHMS BSC
Account Group
"1-9
A-Z"
PT Security Group
PCAs Name list
User 1
Text Field
Patient Hub Email Address
Not Invited
Place of Service
12 Home to 17 Walkin Retail clinic
Date of Admission
Date Selection
Date of Discharge
Date Selection
Delivery Addresses
Active Addresses Only
Address
City
State
County
Country
Postal Code
_____-____
Description
Text Field
Phone
(___) ___-____
Zone (None)
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