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Abbreviation |
Description |
Format |
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Patient Data Fields |
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LName |
Last Name |
<<LName>> |
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FName |
First Name |
<<FName>> |
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MI |
Middle Initial |
<<MI>> |
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Street |
Street Address |
<<Street>> |
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Street2 |
Street Address 2nd Line |
<<Street2>> |
|
City |
City |
<<City>> |
|
State |
State |
<<State>> |
|
Zip |
Zip Code |
<<Zip>> |
|
HPhone |
Home Phone Number |
<<HPhone>> |
|
MPhone |
Mobile Phone Number |
<<MPhone>> |
|
WPhone |
Work Phone Number |
<<WPhone>> |
|
WExt |
Work Phone Extension |
<<WExt>> |
|
SS |
Social Security Number |
<<SS>> |
|
Chart |
Chart Number |
<<Chart>> |
|
Gender |
Gender |
<<Gender>> |
|
Status |
Status |
<<Status>> |
|
FamPos |
Family Position |
<<FamPos>> |
|
BirthDate |
Birth Date |
<<BirthDate>> |
|
PrefName |
Preferred Name |
<<PrefName>> |
|
FirstVisit |
First Visit Date |
<<FirstVisit>> |
|
LastVisit |
Last Visit Date |
<<LastVisit>> |
|
LastRef |
Last Referral Date |
<<LastRef>> |
|
Salutation |
Salutation |
<<Salutation>> |
|
Title |
Formal Title (Mr./Mrs.) |
<<Title>> |
|
OtherID |
ID for Medicaid, etc. |
<<OtherID>> |
|
Language |
Language |
<<Language>> |
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Practice Data Fields |
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Practice_Name |
Practice Name |
<<Practice_Name>> |
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Practice_Address |
Street Address |
<<Practice_Address>> |
|
Practice_Address2 |
Street Address 2nd Line |
<<Practice_Address2>> |
|
Practice_CitySTZip |
City, State, Zip |
<<Practice_CitySTZip>> |
|
Practice_Phone |
Phone Number |
<<Practice_Phone>> |
|
Practice_PhoneExt |
Phone Extension |
<<Practice_PhoneExt>> |
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Billing Data Fields |
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Billing_Type |
Billing Type |
<<Billing_Type>> |
|
Aging_0 |
Balance 30 Days or Less |
<<Aging_0>> |
|
Aging_30 |
Balance Over 30 Days |
<<Aging_30>> |
|
Aging_60 |
Balance Over 60 Days |
<<Aging_60>> |
|
Aging_90 |
Balance Over 90 Days |
<<Aging_90>> |
|
Balance |
Account Balance |
<<Balance>> |
|
LastPayDate |
Last Payment Date |
<<LastPayDate>> |
|
LastPayAmt |
Last Payment Amount |
<<LastPayAmt>> |
|
Guar_LName |
Guarantor's Last Name |
<<Guar_LName>> |
|
Guar_FName |
Guarantor's First Name |
<<Guar_FName>> |
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|
Insurance Data Fields |
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PIns_Name |
Primary Dental Insurance Name |
<<PIns_Name>> |
|
PIns_RemBenf |
Primary Dental Insurance Remaining Benefit |
<<PIns_RemBenf>> |
|
PrSubID |
Primary Dental Insurance Subscriber ID |
<<PrSubID>> |
|
SIns_Name |
Secondary Dental Insurance Name |
<<SIns_Name>> |
|
SIns_RemBenf |
Secondary Dental Insurance Remaining Benefit |
<<SIns_RemBenf>> |
|
SecSubID |
Secondary Dental Insurance Subscriber ID |
<<SecSubID>> |
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Employer Data fields |
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Emp_Name |
Employer Name |
<<Emp_Name>> |
|
Emp_Add1 |
Street Address |
<<Emp_Add1>> |
|
Emp_Street2 |
Street Address 2nd Line |
<<Emp_Street2>> |
|
Emp_Add2 |
City, State, Zip |
<<Emp_Add2>> |
|
Emp_Phone |
Phone Number |
<<Emp_Phone>> |
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|
Referred By Data Fields |
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|
RefBy_Name |
Referred By Last Name / Description |
<<RefBy_Name>> |
|
RefBy_FName |
Referred By First Name |
<<RefBy_FName>> |
|
RefBy_MI |
Referred By Middle Initial |
<<RefBy_MI>> |
|
RefBy_Title |
Referred By Title |
<<RefBy_Title>> |
|
RefBy_Salutation |
Referred By Salutation |
<<RefBy_Salutation>> |
|
RefBy_Add1 |
Referred By Street Address |
<<RefBy_Add1>> |
|
RefBy_Street2 |
Referred By Street Address 2nd Line |
<<RefBy_Street2>> |
|
RefBy_Add2 |
Referred By City, State, Zip |
<<RefBy_Add2>> |
|
RefBy_Phone |
Referred By Phone Number |
<<RefBy_Phone>> |
|
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|
Referred To Data Fields |
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|
RefTo_Name |
Referred To Last Name / Description |
<<RefTo_Name>> |
|
RefTo_FName |
Referred To First Name |
<<RefTo_FName>> |
|
RefTo_MI |
Referred To Middle Initial |
<<RefTo_MI>> |
|
RefTo_Title |
Referred To Title |
<<RefTo_Title>> |
|
RefTo_Salutation |
Referred To Salutation |
<<RefTo_Salutation>> |
|
RefTo_Add1 |
Referred To Street Address |
<<RefTo_Add1>> |
|
RefTo_Street2 |
Referred To Street Address 2nd Line |
<<RefTo_Street2>> |
|
RefTo_Add2 |
Referred To City, State, Zip |
<<RefTo_Add2>> |
|
RefTo_Phone |
Referred To Phone Number |
<<RefTo_Phone>> |
|
RefTo_Date |
Date Referral Made |
<<RefTo_Date>> |
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Payment Plan Data Fields |
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PP_Total |
Future Due Payment Plan Total |
<<PP_Total>> |
|
PP_Balance |
Future Due Payment Plan Balance |
<<PP_Balance>> |
|
PP_Payment |
Future Due Payment Plan Agreed Payment |
<<PP_Payment>> |
|
PP_Payment_Date |
Future Due Payment Due Date |
<<PP_Payment_Date>> |
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Provider Data Fields |
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Prov_Name |
Primary Provider Name |
<<Prov_Name>> |
|
Prov_Title |
Primary Provider Title |
<<Prov_Title>> |
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Appointment Data Fields |
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Appt_Date |
Appointment Date |
<<Appt_Date>> |
|
Appt_Time |
Appointment Time |
<<Appt_Time>> |
|
Appt_Reason |
Appointment Reason |
<<Appt_Reason>> |
|
Appt_Name |
Appointment Name |
<<Appt_Name>> |
|
Appt_Provider |
Appointment Provider Name |
<<Appt_Provider>> |
|
Appt_Prov_ID |
Appointment Provider ID |
<<Appt_Prov_ID>> |
|
Appt_Phone |
Appointment Phone Number |
<<Appt_Phone>> |
|
Appt_Add1 |
Appointment Street Address |
<<Appt_Add1>> |
|
Appt_Street2 |
Appointment Street Address 2nd Line |
<<Appt_Street2>> |
|
Appt_Add2 |
Appointment City, State, ZIP |
<<Appt_Add2>> |
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Continuing Care Data Fields |
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CC_DueDate |
Continuing Care Due Date |
<<CC_DueDate>> |
|
CC_TypeName |
Continuing Care Type Name |
<<CC_TypeName>> |
|
CC_TypeDesc |
Continuing Care Type Description |
<<CC_TypeDesc>> |
|
CC_Note |
Continuing Care Note |
<<CC_Note>> |
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CC_PriorWorkDate |
Continuing Care Prior Treatment Date |
<<CC_PriorWorkDate>> |
|
CC_ApptDate |
Continuing Care Appointment Date |
<<CC_ApptDate>> |
|
CC_ApptTime |
Continuing Care Appointment Time |
<<CC_ApptTime>> |
|
CC_ApptReason |
Continuing Care Appointment Reason |
<<CC_ApptReason>> |
|
CC_ApptProv |
Continuing Care Appointment Provider |
<<CC_ApptProv>> |
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Date of Service Data Fields |
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|
ProcDate |
Procedure Date* |
<<ProcDate>> |
|
Charge |
Charge* |
<<Charge>> |
|
InsPmts |
Insurance Payments* |
<<InsPmts>> |
|
* Procedure Date, Charge, and Insurance Payments are linked together as a group, so all three must be selected if any one of these data elements is needed. |
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