Input Field Names

See Sheet Input Field.

Input Fields are Sheet Field Types where patients input information when filling out forms. This list is in progress and not all fields have a description yet. The available input fields vary by sheet type.

Output Text Field Name Description
notes Available for:
  • Referral Slips. Input notes specific to the referral source.
  • Rx. Not used.
  • Lab Slips.
toothnum Available for Consents. Input tooth number (e.g. extraction consent)
misc Available for Consents, Patient Forms, Medical Histories, Lab Slips, Exam Sheets
Input miscellaneous notes.
address
address 2
Birthdate
City
Email
Fname
HmPhone
ICEName Available for Patient Forms and Medical Histories. Emergency contact name.
ICEPhone Available for Patient Forms and Medical Histories. Emergency contact phone number.
ins1CarrierName
ins1CarrierPhone
ins1EmployerName
ins1GroupName
ins1GroupNum
ins1SubscriberID
ins1SubscriberNameF
ins2CarrierName
ins2CarrierPhone
ins2EmployerName
ins2GroupName
ins2GroupNum
ins2SubscriberID
ins2SubscriberNameF
LName
MiddleI
Preferred Available for Patient Forms. Patient preferred name
referredFrom Available for Patient Forms. Where patient was referred from.
SSN
State
WkPhone
WirelessPhone
wirelessCarrier
Zip
inputMed 1-20 Available for Medical Histories. Input medications. Up to 20 allowed on a sheet.
labcase.Instructions Available for Lab Slips. Input lab instructions.
Grade Level Available for Exam Sheets. Input patient's grade in school.
Race/Ethnicity Available for Exam Sheets. Input patient's race or ethnicity.
Urgency Available for Exam Sheets.
Comments Available for Exam Sheets. Input additional comments about patient's health.