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.
| Input Text Field Name | Description |
|---|---|
| notes | Available for:
|
| 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 | Patient birthdate. Date format typically follows the format of where the practice is located (e.g., US vs Canada). |
| City | |
| 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 | Requires two character state abbreviation (e.g., OR, WA, CA). Cannot be used in conjunction with StateNoAbbreviation on the same sheet. |
| StateNoValidation | Does not require two character state abbreviation. Cannot be used in conjunction with State on the same sheet. |
| 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. |