COLUMN HEADERS |
-
- Facility
- SEQUENCE: 1
- PRINT LENGTH: 10
- INCLUDE ON PRINT: YES
-
- Home phone
- SEQUENCE: 10
-
- Home Address
- SEQUENCE: 11
- TYPE: WORD PROCESSING
- INCLUDE ON DETAIL: YES
- INCLUDE ON PRINT: YES
-
- Race
- SEQUENCE: 12
- TYPE: WORD PROCESSING
- INCLUDE ON DETAIL: YES
-
- Ethnicity
- SEQUENCE: 13
- TYPE: WORD PROCESSING
- INCLUDE ON DETAIL: YES
-
- Next of kin
- SEQUENCE: 14
-
- Relationship
- SEQUENCE: 15
-
- NOK Address
- SEQUENCE: 16
- TYPE: WORD PROCESSING
- INCLUDE ON DETAIL: YES
-
- Patient Name
- SEQUENCE: 3
- PRINT LENGTH: 20
- INCLUDE ON PRINT: YES
- PRINT TITLE: Name
-
- Sensitive
- SEQUENCE: 17
-
- ID
- VISIBLE: NO
- SEQUENCE: 2
-
- SIGI
- SEQUENCE: 6
- PRINT LENGTH: 10
- INCLUDE ON PRINT: YES
-
- Social Security #
- SEQUENCE: 4
- PRINT LENGTH: 11
- INCLUDE ON PRINT: YES
- PRINT TITLE: SSN
-
- Date of Birth
- SEQUENCE: 7
- PRINT LENGTH: 12
- INCLUDE ON PRINT: YES
- PRINT TITLE: DOB
-
- Religion
- SEQUENCE: 8
-
- Birth Sex
- SEQUENCE: 5
- PRINT LENGTH: 4
- INCLUDE ON PRINT: YES
- PRINT TITLE: SEX
-
- Marital status
- SEQUENCE: 9
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