Patient Tab - Professional

Code indicating the relationship of the patient to the person insured. Required when the patient is the subscriber or is considered to be the subscriber. Options are:

Last name of the person to whom the services were provided.

First name of the person to whom the services were provided.

Middle initial of the patient.

Additional descriptive information at the end of the patient's name (e.g. Jr.).

Street number and name of the mailing address of the patient (or post office box number or RFD), and additional address information.

Postal code of the address where the patient lives. When a user enters a zip code in a zip code field and clicks tab to move to the next field, the city and state fields are automatically generated based on data received from the USPS. Note: This replaces any data already entered in the city/state fields.

Name of the city where the patient lives.

Two-letter code for the state or province where the patient lives.

The country where the patient lives.

Code identifying the country subdivision.

The date of birth of the patient.

The gender of the patient as recorded at date of admission, outpatient service, or start of care. Options are:  

Date of death of the patient, if applicable (format is MM/DD/CCYY).

This field is used when the patient's age is less than 29 days, but is required on the following types of claims/encounters:

• For delivery services (newborn's birthweight)
• Claims/encounters involving EPO (epoetin)
• Patients on dialysis
• Medicare Durable Medical Equipment Regional Carrier's certificate of medical necessity

Patient’s unique alpha-numeric number assigned by the provider to facilitate retrieval of individual financial records and posting of the payment.

The number assigned to the patient’s medical/health record by the provider. Also called a chart number.

Code indicating whether the provider has on file a signed statement permitting the release of medical data to other organizations.

Code identifying the type of facility where services were performed. The drop-down menu displays the options. Options are:

A Y value indicates the provider signature is on file; an N value indicates the provider signature is not on file with the provider.

Mark check box if signature generated by provider or an entity other than the patient because the patient was not physically present for services. Required when a signature was executed on the patient’s behalf under state or federal law.

Mark the check box if the patient is pregnant.