Document merge fields

Abbreviation

Description

LName

Last Name

FName

First Name

MI

Middle Initial

Street

Street Address

Street2

Street Address 2nd Line

City

City

State

State

Zip

Zip Code

HPhone

Home Phone Number

MPhone

Mobile Phone Number

WPhone

Work Phone Number

WExt

Work Phone Extension

SS

Social Security Number

Chart

Chart Number

Gender

Gender

Status

Status

FamPos

Family Position

BirthDate

Birth Date

PrefName

Preferred Name

FirstVisit

First Visit Date

LastVisit

Last Visit Date

LastRef

Last Referral Date

Salutation

Salutation

Title

Formal Title (Mr./Mrs.)

OtherID

ID for Medicaid, etc.

Language

Language

E-Mail

E-Mail Address

Practice_Name

Practice Name

Practice_Address

Street Address

Practice_Address2

Street Address 2nd Line

Practice_CitySTZip

City, State, Zip

Practice_Phone

Phone Number

Practice_PhoneExt

Phone Extension

Billing_Type

Billing Type

Aging_0

Balance 30 Days or Less

Aging_30

Balance Over 30 Days

Aging_60

Balance Over 60 Days

Aging_90

Balance Over 90 Days

Balance

Account Balance

LastPayDate

Last Payment Date

LastPayAmt

Last Payment Amount

Guar_LName

Guarantor’s Last Name

Guar_FName

Guarantor’s First Name

PIns_Name

Primary Dental Insurance Name

PIns_RemBenf

Primary Dental Insurance Remaining Benefit

PrSubID

Primary Dental Insurance Subscriber ID

SIns_Name

Secondary Dental Insurance Name

SIns_RemBenf

Secondary Dental Insurance Remaining Benefit

SecSubID

Secondary Dental Insurance Subscriber ID

Emp_Name

Employer Name

Emp_Add1

Street Address

Emp_Street2

Street Address 2nd Line

Emp_Add2

City, State, Zip

Emp_Phone

Phone Number

RefBy_Name

Referred By Last Name / Description

RefBy_FName

Referred By First Name

RefBy_MI

Referred By Middle Initial

RefBy_Title

Referred By Title

RefBy_Salutation

Referred By Salutation

RefBy_Add1

Referred By Street Address

RefBy_Street2

Referred By Street Address 2nd Line

RefBy_Add2

Referred By City, State, Zip

RefBy_Phone

Referred By Phone Number

RefTo_Name

Referred To Last Name / Description

RefTo_FName

Referred To First Name

RefTo_MI

Referred To Middle Initial

RefTo_Title

Referred To Title

RefTo_Salutation

Referred To Salutation

RefTo_Add1

Referred To Street Address

RefTo_Street2

Referred To Street Address 2nd Line

RefTo_Add2

Referred To City, State, Zip

RefTo_Phone

Referred To Phone Number

RefTo_Date

Date Referral Made

PP_Total

Future Due Payment Plan Total

PP_Balance

Future Due Payment Plan Balance

PP_Payment

Future Due Payment Plan Agreed Payment

PP_Payment_Date

Future Due Payment Due Date

Prov_Name

Primary Provider Name

Prov_Title

Primary Provider Title

Prov_NPI

Primary Provider NPI

Appt_Date

Appointment Date

Appt_Time

Appointment Time

Appt_Reason

Appointment Reason

Appt_Name

Appointment Name

Appt_Provider

Appointment Provider Name

Appt_Prov_ID

Appointment Provider ID

Appt_Phone

Appointment Phone Number

Appt_Add1

Appointment Street Address

Appt_Street2

Appointment Street Address 2nd Line

Appt_Add2

Appointment City, State, ZIP

CC_DueDate

Continuing Care Due Date

CC_TypeName

Continuing Care Type Name

CC_TypeDesc

Continuing Care Type Description

CC_Note

Continuing Care Note

CC_PriorWorkDate

Continuing Care Prior Treatment Date

CC_ApptDate

Continuing Care Appointment Date

CC_ApptTime

Continuing Care Appointment Time

CC_ApptReason

Continuing Care Appointment Reason

CC_ApptProv

Continuing Care Appointment Provider

ProcDate

Procedure Date

Charge

Charge

InsPmts

Insurance Payments