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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