Prompt | Response | Req | Len |
---|---|---|---|
Patient's Last Name | Type the patient's last name. | 60 | |
First Name | Type the patient's first name. | 35 |
Prompt | Response | Req | Len |
---|---|---|---|
Patient Name (L, S, F, M) | Informational only - displays the patient's last name. | 60 | |
Suffix | Enter the patient's Suffix. | 10 | |
First Name | Informational only - displays the patient's first name. | 35 | |
Middle Name | Type the patient's middle name. | 25 | |
Address Line One | Type the patient's address. | 28 | |
Two | Type any additional address information. | 28 | |
Zip Code | Type the five digit zip code or the zip-plus-four zip code. | 10 | |
City | Type the city. | 15 | |
State Code | In the State Code list, click the state you want. | 3 | |
Telephone/Cell Phone | Type the patient's home telephone number in the first text box and their cell phone in the second text box. You can enter a phone number with or without the area code. If you do not enter an area code, CGM webPRACTICE will automatically use the default area code of the practice. You can also enter the phone number with or without dashes to separate the prefix and suffix of the telephone number. | 20 | |
20 | |||
E-Mail Address | Type the patient's e-mail address. | 50 | |
Responsible Doctor | In the Responsible Doctor text box, type the doctor you want or select from the Responsible Doctor list. | 3 | |
Default Diagnosis | In the Default Diagnosis box, type the code you want or click the magnifying glass to search the table. | 10 | |
Rel to Guarantor | In the Rel to Guarantor list, click the relationship status of the patient to the guarantor. | 1 | |
Birth Date | In the Birth Date box, type the date you want or click the calendar icon to select a date. | 10 | |
Language | For the Patient's Sex options, select the option you want. | 3 | |
Patient's Sex | For the Patient's Sex options, select the option you want. | 1 | |
Patient's Status | In the Patient's Status list, click the status of the patient. | 2 | |
Social Security # | Type the patient's nine-digit social security number with or without dashes. | 11 | |
Referral Source | In the Referral Source box, type the code you want or click the magnifying glass to search the table. | 6 | |
Insurance Carrier | In the Insurance Carrier box, type the patient's primary insurance code you want or click the magnifying glass to search the table. | 5 | |
Policy Number | Type the patient's primary insurance policy number. | 20 | |
Internal Comment | Type any comments needed for this patient. This is a free-text field that will be displayed throughout CGM webPRACTICE whenever the patient's account is accessed using the Patient Look-up function. This comment does not print on any report. | 45 | |
Report Comment | Type any comments needed for this patient. This is a free-text field that will be printed on every report that contains this patient. | 45 |