Download Chapter 10 - Merge Fields

Location
Example
Patient
Rx
Description
Order
Field Name
Calendar
Exam
Table 3 - Merge fields available for each letter type
APPOINTMENT_DATE
Date of the exam
appointment
10/16/2011
APPOINTMENT_NEXT
Date of the next appointment
10/16/2012
■ ■ ■ ■ ■
APPOINTMENT_REASON
Name of the service
scheduled for the
appointment
EXAM; COMPREHENSIVE, ESTABLISHED
PATIENT
■
APPOINTMENT_STATUS
Appointment status
Canceled
■
APPOINTMENT_TIME
Time of the appointment
[h:mm am/pm]
8:00 AM
■
BALANCE
Outstanding balance for the
patient's account [0.00]
3735.56
■ ■ ■ ■
BALANCEINSURANCE
Outstanding insurance
balance for the patient's
account [0.00]
608.86
■ ■ ■ ■
BALANCEPATIENT
Outstanding patient balance
for the patient's account
[0.00]
3126.7
■ ■ ■ ■
CALENDAR_APPOINTMENT_LENGTH
Length of the appointment in
minutes
30
■
CALENDAR_NOTES
Appointment notes
Patient is on Dr. Snellen's wait list for Saturday
■
CANCEL_REASON
Appointment cancellation
reason
Traffic
■
COMPUTER_FLAG
Computer use flag in ROS
[Yes/No]
Yes
DATE_TODAY
Current date [d-Mmm-yy]
9-Oct-10
DATE_TODAY_DATE_AND_TIME
Current date [dd/mm/yyyy
hh:mm:ss]
10/11/2010 09:17:08:52
■
DATE_TODAY_DDMMYYYY
Current date [dd/mm/yyyy]
13/10/2010
■
DATE_TODAY_MMDDYY
Current date [mm dd yy]
10 12 10
DATE_TODAY_MMDDYYYY
Current date [mm/dd/yyyy]
10/13/2010
DAYS030
Aged balance on patient's
account (including insurance)
0-30 days [0.00]
3465.27
■ ■ ■ ■
DAYS3160
Aged balance on patient's
account (including insurance)
31-60 days [0.00]
90.4
■ ■ ■ ■
DAYS6190
Aged balance on patient's
account (including insurance)
61-90 days [0.00]
0
■ ■ ■ ■
DAYS91
Aged balance on patient's
account (including insurance)
over 90 days [0.00]
179.89
■ ■ ■ ■
EXAM_ACA
AccommodativeConvergence/Accommodatio Binocular
n (AC/A) Ratio
EXAM_ACCOMPANIED_BY
Person accompanying
patient to the exam
Summary
Emma Darwin
■
EXAM_ACCOMPANIED_BY_RELATIONSHIP
Relationship of
accompanying person to the
patient
Summary
Spouse
■
EXAM_ADDENDUM
Exam addendum notes
Assessment
EXAM_ASSESSMENT
Assessment
Assessment
ASSESSMENT:
Myopia
■
EXAM_AV_RATIO
Artery to Vein (AV) ratios
Internal
AV RATIO:
OD: 3/2
OS: 3/2
■
EXAM_AV_RATIO_OD
OD Artery to Vein (AV) ratio
Internal
3/2
■
EXAM_AV_RATIO_OS
OS Artery to Vein (AV) ratio
Internal
3/2
■
■
■
■ ■ ■ ■ ■
■
■
■
■
EXAM_AIDEDVA
Example
EXAM_B14_OD
OD Dynamic Cross Cylinder
(14B)
Binocular
14B: OD:
+1.00
■
EXAM_B14_OS
OS Dynamic Cross Cylinder
(14B)
Binocular
14B: OS:
+1.00
■
EXAM_BINOCULAR_TEST_NAME
Binocular Balance test name Binocular
Red-Green Equalization
■
EXAM_BINOCULAR_TEST_NOTE
Binocular Balance notes
Binocular
Accommodative effort of both eyes is equalized
■
EXAM_BINOLCULAR_NOTE
Binocular tab notes
Binocular
EXAM_BLOODPRESSURE
Blood pressure
ROS
(systolick/diastolic) and pulse
EXAM_BLOODPRESSURE_ALL
Historical readings of blood
pressure
[Mmm d yyyy h:mm:ss
diastolic/sistolic Pulse: 00]
■
120/80 Pulse: 80
■
Oct 1 2010 12:00PM 120/80 Pulse: 80
Apr 23 2010 12:00PM 122/75 Pulse: 75
ROS
■
Nov 5 2009 12:00PM 120/80 Pulse: 80
Mar 3 2008 4:53PM 120/80 Pulse: 80
EXAM_BLOODPRESSURE_DATETIME
Date and time when blood
pressure reading was taken
[Mmm d yyyy h:mm:ss]
ROS
Oct 1 2010 12:00PM
■
CUP/DISC RATIO:
EXAM_CD_RATIO
Cup to Disc (CD) ratio
Internal
OD: Horz: 0.30 Vert: 0.20
■
EXAM_CD_RATIO_HOR_OD
OD Horizontal Cup to Disc
(CD) ratio
Internal
0.3
■
EXAM_CD_RATIO_HOR_OS
OS Horizontal Cup to Disc
(CD) ratio
Internal
0.2
■
EXAM_CD_RATIO_VERT_OD
OD Vertical Cup to Disc (CD)
Internal
ratio
0.2
■
EXAM_CD_RATIO_VERT_OS
OS Vertical Cup to Disc (CD)
Internal
ratio
0.2
■
EXAM_CHIEF_COMPLAINT
Reason for visit
OS: Horz: 0.20 Vert: 0.20
CHIEF COMPLAINT:
Complaint
■
Wants contact lens fitting
EXAM_CLENS_DETAILED_EXTENDED_FINAL}
Final contact lens
prescription extented
Contacts
CONTACT LENS FINAL Rx:
OD: Bausch & Lomb Purevision -5.75 +0.00 000 8.30 14.00
DVA: 20/20 NVA: 20/20 Clear
Sphere/Cylinder Over-Refraction: PL D.S. Sphere OverRefraction: PL
OS: Bausch & Lomb Purevision -5.75 +0.00 000 8.30 14.00
DVA: 20/20 NVA: 20/20 Clear
Sphere/Cylinder Over-Refraction: PL D.S. Sphere OverRefraction: PL
■
■
{EXAM_CLENS_DETAILED_EXTENDED_PRESENTING}
Presenting contact lens
prescription extented
Contacts
CONTACT LENS PRESENTING Rx:
OD: Bausch & Lomb Purevision -5.75 +0.00 000 8.30 14.00
DVA: 20/20 NVA: 20/20 Clear
Sphere/Cylinder Over-Refraction: PL D.S. Sphere OverRefraction: PL
OS: Bausch & Lomb Purevision -5.75 +0.00 000 8.30 14.00
DVA: 20/20 NVA: 20/20 Clear
Sphere/Cylinder Over-Refraction: PL D.S. Sphere OverRefraction: PL
EXAM_CLENS_FINAL
Final contact lens
prescription
Contacts
FINAL CONTACT RX: OD: Bausch & Lomb DW 0.25 D.S. BC: 8.40 OS: Bausch & Lomb DW -0.50
D.S. BC: 8.40
■
EXAM_CLENS_PRESENTING
Presenting contact lens
prescription
Contacts
CONTACT LENS RX:
OD: Bausch & Lomb DW -0.50 D.S. BC: 8.40
OS: Bausch & Lomb DW -0.50 D.S. BC: 8.40
■
EXAM_COLOR_VISION
Color vision notes
Entrance
COLOR VISION:
Test: Farnsworth D-15
Result - OD: Acquired color vision deficiencies OS:
Acquired color vision deficiencies
■
EXAM_COMPUTER_CL_WORN
Does patient wears contact
during computer use?
[Yes/No]
ROS
Ergonomics of computer
monitor
ROS
EXAM_COMPUTER_ERGONOMIC
WEARS CONTACTS WHEN USING COMPUTER:
■
No
ERGONOMIC:
■
has monitor positioned above eye level
Patient
Rx
Location
Order
Description
Calendar
Exam
Field Name
Example
EXAM_COMPUTER_FLAG
Does patient use computers?
ROS
[Yes/No]
COMPUTER USE: Yes
■
EXAM_COMPUTER_HOURS
Computer use in hours per
day
ROS
HOURS:
2-4 hours
■
EXAM_COMPUTER_USAGE
Description of computer
usage
ROS
USAGE:
moderate usage
■
COVER TEST:
Far - Lateral - Prism: 10 Eye type: EsoPhoria
Vertical - Prism: 10 Eye type: 2
Near - Lateral - Prism: 20 Eye type: EsoPhoria
Vertical - Prism: 6 Eye type: Hyperphoria OD
■
EXAM_COVER_TEST
Cover test far lateral eye type Entrance
EXAM_CUSTOM_FIELD_21 - EXAM_CUSTOM_FIELD_50
Custom fields for the exam
EXAM_CVF
Confrontation Visual Field,
Full Field Confrontation
[Yes/No]
Entrance
EXAM_DIABETIC
Flag indicating whether the
patient is diabetic or not
[Yes/No]
Internal
No
■
EXAM_DIAGNOSIS_1
Diagnosis code 1
Assessment
367.1
■
EXAM_DIAGNOSIS_1_CD_DESCRIPTION
Diagnosis code 1 and
description
Assessment
367.1 Myopia
■
EXAM_DIAGNOSIS_2
Diagnosis code 2
Assessment
372.51
■
EXAM_DIAGNOSIS_2_CD_DESCRIPTION
Diagnosis code 2 and
description
Assessment
372.51 Pingueculum
■
EXAM_DIAGNOSIS_3
Diagnosis code 3
Assessment
■
EXAM_DIAGNOSIS_3_CD_DESCRIPTION
Diagnosis code 3 and
description
Assessment
■
EXAM_DIAGNOSIS_4
Diagnosis code 4
Assessment
■
EXAM_DIAGNOSIS_4_CD_DESCRIPTION
Diagnosis code 4 and
description
Assessment
■
EXAM_DILATION
Dilating drops (mydriatics)
used
Internal
EXAM_DILATION_FLAG
Flag indicating whether the
patient was dilated for the
exam or not [yes/no]
Internal
EXAM_DILATION_START
Time when dilating drops
were applied
Internal
Custom
■
CVF: FFC:
■
Yes
DILATION ORDERS:
Unknown
■
■
■
DISC SIZE:
Size of the optic disc
[Small/Regular/Large]
Internal
EXAM_DISC_TYPE
Symmetry of the optic disc
[Symmetrical/Asymmetrical]
Internal
EXAM_DOMINANT_EYE
Dominant eye [OD/OS/None] Entrance
EXAM_DISC_SIZE
Tropicamide 1.0%, Phenylephrine 2.5% W/Anesthetic
at 4:43 PM
■
Regular
Symmetrical
■
DOMINANT EYE:
■
OD
DOMINANT HAND:
Dominant hand
[Right/Left/None]
Entrance
EXAM_DT_DDMMYYYY
Exam date [d/m/yyyy]
Entrance
31/10/2010
■
EXAM_DT_MMDDYYYY
Exam date [m/d/yyyy]
Entrance
10/31/2010
■
EDUCATION:
Cataracts
Macular Degeneration
■
EXAM_DOMINANT_HAND
EXAM_EDUCATION
Education material shown or
given to the patient
Assessment
EXAM_ENTRANCE_NOTES
General entrance notes
Entrance
Right
■
■
■
EXAM_EOMS
EXAM_EXAM_ALERT
Text in this field will be
displayed in a message box
when the exam is opened
EXAM_EXAM_ID
Exam ID [incremental unique
identifier automatically
assigned to each exam]
Header
■
913
■
Patient
Rx
Location
Order
Description
Calendar
Exam
Field Name
Example
EXAM_EXAM_STATUS
Specifies whether the exam
is open or locked
[Open/Locked]
Patient
Open
■
EXAM_EXAM_TYPE
Type of exam performed
Summary
Comprehensive Exam
■
EXAM_EXTERNAL_IMAGE
Inserts the image of the
external eye with the doctor's External
notations and drawings
EXTERNAL IMAGE
■
External eye findings
Lid - OU: Eyelid and eyelashes are of normal position
and function and free of disease. OD:
Blepharospasm. Pupil - OU: Pupil is Equa, Round
, Reactive to Light and Accommodation. OD: Pupil
size: 3mm. OS: Pupil size: 3mm. Lacrimal System OU: Lacrimal system shows adequate tear production
and drainage. Conjunctiva - OU: Bulbar and palpebral
conjunctiva is clear and without signs of inflammation.
OD: Pinguecula. OS: Pinguecula. Cornea - OU:
Cornea of normal size without signs of opacification
or scarring. Anterior Chamber - OU: Slit lamp
examination noted chambers of normal depth and
without signs of cells or flare. Iris - OU: Iris is healthy
with normal anatomy and convexity. Tear Film - OU:
Tear film of adequate volume and consistency. Sclera
- OU: Sclera is white and shows no signs of
inflammation and has no marked thinning.
Preauricular Node - OU: Preauriular node shows no
signs of swelling and no tenderness to palpitation.
■
EXAM_EXTERNAL_NOTE
External
■
EXAM_EYE_COLOR
FAMILY SYSTEM AND OCULAR HISTORY:
PATIENT_FAMILY_HISTORY
Conditions afflicting patient's
family
EXAM_FUSION
Distance of the distant point
in the binocular fusion test
Binocular
EXAM_FUSION_IMPRESSION
Visual impression
Binocular
PFSH
Diabetes
■
Glaucoma, Mother
DIST:
20'
■
IMPRESSION:
■
Supression OD
EXAM_FUSION_NEAR
Distance of the near point in
the binocular fusion test
Binocular
NEAR:
14"
■
EXAM_GLARE_COMPUTER
Computer program to aid in
reading
Low Vision
Zoom Text
■
EXAM_GLARE_INDOORS
Tint for indoor glasses
Low Vision
Yelllow 450
■
EXAM_GLARE_OUTDOORS
Tint for outdoor glasses
Low Vision
Amber Polarized
■
EXAM_GLARE_TINTED_GLASSES
Low vision "Continue with
current tinted glasses?"
question [Yes/No/Unknown]
Low Vision
Yes
■
EXAM_GONIOSCOPY_OD
Gonioscopy observations for
OD
Test
OD:
The drainage angle appears normal, is wide open
and is not blocked.
■
HPI:
108 year old male complains of double vision.
Location is both eyes. Severity was described as
severe. Patient reported the following signs and
symptoms: pain
EXAM_HISTORY_OF_PRESENT_ILLNESS
History of Present Illness
(HPI)
Complaint
light sensitivity. The duration is 4 hours. Quality was
described as sharp. The timing is continous.
■
108 year old male complains of headaches. Location
is across forehead. Severity was described as
severe. The duration is 2 hours. Quality was
described as sharp. The timing is frequently. Context
is reported as working on computer.
EXAM_INSURANCE
Insurance company that will
cover the exam
EXAM_INSURANCE_PLAN
Insurance plan that will cover
Header
the exam
Header
VSP
■
Signature
■
Patient
Rx
Location
Order
Description
Calendar
Exam
Field Name
Example
Inserts the image of the
internal eye with the doctor's
notations and drawings
INTERNAL IMAGE
■
EXAM_INTERNAL_NOTE
Exam notes on the internal
eye
Lens - OU: Lens is clear and centered and without
opacifictaion. OD: Cataract Congenital. Vitreous OU: Vitreous indicates no liquifaction and no visible
floaters. Optic Disc - OU: Optic Disc shows no
indication of pallor or swelling with intact neuro-retinal
rims 360 degrees. Flat and sharp borders noted
with well-defined visible nerve fiber layer. Vessels OU: Vessels show normal A/V ratio and free of
tortuosity and crossing defects with no visible
plaquing. Macula - OU: Maculae appears healthy
free of drusion or holes and exhibits reflex. Retina OD: White Without Pressure. OS: White Without
Pressure.
■
EXAM_IOP
Intra ocular pressure reading
External
for current exam
TONOMETRY:
Oct 20 2010 10:55AM Examination Test: NonContact OD: 23 OS: 23
■
EXAM_IOP_ALL
Intra ocular pressure reading
for current and previous
External
exams
EXAM_INTERNAL_IMAGE
Oct 20 2010 10:55AM Test: Non-Contact OD: 23
OS: 236.0
■
Sep 28 2010 11:59AM Test: Non-Contact OD: 21.0
26.0
KERATOMETRY:
EXAM_KERATOMETRY
Keratometry readings
Refractive
OD: 43.50 @ 180 / 44.00 @ 90 Clear
■
EXAM_KERATOMETRY_METHOD
Keratometry method
Refractive
EXAM_KERATOMETRY_OD_HORIZ_AXIS
Keratometry reading of
horizontal axis for OD in
degrees
Refractive
180
■
EXAM_KERATOMETRY_OD_HORIZ_DIOPTER
Keratometry reading of
horizontal corneal curvature
for OD in diopters
Refractive
43.5
■
EXAM_KERATOMETRY_OD_MIRES
Keratometry reading of mires
Refractive
for OD
Clear
■
EXAM_KERATOMETRY_OD_VERT_AXIS
Keratometry reading of
vertical axis for OD in
degrees
Refractive
90
■
EXAM_KERATOMETRY_OD_VERT_DIOPTER
Keratometry reading of
horizontal corneal curvature
for OD in diopters
Refractive
44
■
EXAM_KERATOMETRY_OS_HORIZ_AXIS
Keratometry reading of
horizontal axis for OS in
degrees
Refractive
180
■
EXAM_KERATOMETRY_OS_HORIZ_DIOPTER
Keratometry reading of
horizontal corneal curvature
for OS in diopters
Refractive
43.87
■
EXAM_KERATOMETRY_OS_MIRES
Keratometry reading of mires
Refractive
for OS
Clear
■
EXAM_KERATOMETRY_OS_VERT_AXIS
Keratometry reading of
vertical axis for OS in
degrees
Refractive
90
■
EXAM_KERATOMETRY_OS_VERT_DIOPTER
Keratometry reading of
horizontal corneal curvature
for OS in diopters
Refractive
44
■
EXAM_LAST_EXAM_DT_DDMMYYYY
Patient's last exam date
[d/m/yyyy]
Summary
21/12/2010
■
EXAM_LAST_EXAM_DT_MMDDYYYY
Patient's last exam date
[m/d/yyyy]
Summary
12/21/2010
■
EXAM_LAST_EXAM_LOCATION
Location of the patient's last
exam
Summary
this office
■
EXAM_LAST_EXAM_WHEN
Description of time interval
since patient's last exam
Summary
one year ago
■
OS: 43.87 @ 180 / 44.00 @ 90 Clear
■
Patient
Rx
Location
Order
Description
Calendar
Exam
Field Name
Example
EXAM_LETTER_ID
Letter ID [unique identifier of
the glance letter specified for Glance
the exam]
10004
■
EXAM_LOCKED_DT_DDMMYYYY
Exam locked date [d/m/yyyy] Patient
21/12/2010
■
EXAM_LOCKED_DT_MMDDYYYY
Exam locked date [m/d/yyyy] Patient
12/21/2010
■
EXAM_LOWVISION_ASSESSMENT
Low vision assessment
Principles of magnification Yes
Eccentric Viewing No
Lighting Yes
■
EXAM_LOWVISION_COMPUTER_MODIFICATION
Flag indicating if the patient
needs computer modification Low Vision
[Yes/No]
Yes
■
EXAM_LOWVISION_FAR_CUSTOM_TS
Low vision custom telescope
required for far distance
Low Vision
vision [Yes/No]
No
■
EXAM_LOWVISION_FAR_ELECTRONIC_SYSTEMS
Low vision electronic
systems required for far
distance vision [Yes/No]
Low Vision
Yes
■
EXAM_LOWVISION_FAR_PREMADE_TS
Low vision pre-made
telescope required for far
distancevision [Yes/No]
Low Vision
No
■
EXAM_LOWVISION_FIELDEXPANSION
Field expansion system
required
Low Vision
OS: Peripheral prism, 8 x 22mm superior and inferior
segments, 40 DS, monocular fit.
■
EXAM_LOWVISION_ITEMS
Low vision items prescribed
Low Vision
OU: 40 DS Magnifying Glass 10 X 20/400 Reading
■
EXAM_LOWVISION_MONITOR_SIZE
Recommended computer
monitor size
Low Vision
30"
■
EXAM_LOWVISION_NEAR_ELECTRONIC_SYSTEMS
Low vision electronic
systems required for near
distance vision [Yes/No]
Low Vision
No
■
EXAM_LOWVISION_NEAR_HAND
Low vision electronic
systems required for near
distance vision [Yes/No]
Low Vision
Yes
■
EXAM_LOWVISION_NEAR_HEAD_BORNE
Low vision pre-made
telescope required for near
distancevision [Yes/No]
Low Vision
No
■
EXAM_LOWVISION_NEAR_STAND
Low vision stand equipment
for near vision
Low Vision
Yes
■
EXAM_LOWVISION_NOTES
Low vision notes
Low Vision
EXAM_LOWVISION_PRESCRIBED
Prescribed low vision
aids/glasses & training time
Low Vision
EXAM_LOWVISION_READ_LP
Does the patient want to read
large print?
Low Vision
[Yes/No/Unknown]
EXAM_LOWVISION_SOFTWARE_SPEECH_OR_LP
Computer software to be
used read the screen aloud
or enlarge text
Low Vision
Zoom Text
■
EXAM_LOWVISION_SPECIAL_KEYBOARD
Special keyboard for low
vision patients
Low Vision
Enhanced Visibility Keyboard
■
■
Low Vision
■
TOPAZ Desk Set: 20 minutes
■
■
EXAM_LOWVISION_TASKS
Low vision tasks
Low Vision
Do you have difficulty travelling alone locally? Major
Problem
Do you have difficulty travelling far alone? No
Problem
Do you have difficulty seeing traffic lights? Unknown
Do you have difficulty seeing street signs? Major
Problem At night
EXAM_LOWVISION_TELEMICROSCOPE_1
Telemicroscope 1
Low Vision
3X WATS
■
EXAM_LOWVISION_TELEMICROSCOPE_2
Telemicroscope 2
Low Vision
+4.00 DS
■
EXAM_LOWVISION_TREATMENT_PLAN_NOTES
Low vision treatment plan
notes
Low Vision
EXAM_MDM_DATA_REVIEW
Data review for medical
decision making
Assessment
[None/Limited/Multiple/Exten
sive]
Multiple
■
EXAM_MDM_RISK
Risk for medical decision
making
[None/Low/Moderate/High]
Low
■
Assessment
■
Patient
Rx
Location
Order
Description
Calendar
Exam
Field Name
Example
EXAM_MDM_SX_OR_DX
Symptom or disease
evaluation for medical
decision making
Assessment
[Minor/Limited/Multiple/Exten
sive]
Limited
■
EXAM_MEDICAL_DECISION_MAKING
Medical decision making
complexity for the exam.
Assessment
MEDICAL DECISION MAKING:
Moderate Complexity
■
EXAM_MEDICATIONS_OCULAR
Ocular medications
PFSH
OCULAR MEDICATIONS:
Denies
■
PATIENT_MEDICATIONS_RX
Medications rx
Assessment
Vigamox Sig: 6xd Anti-infectives
EXAM_NPA
Near point of accomodation
(NPA)
Binocular
■
EXAM_NPC
Near point of convergence
(NPC)
Binocular
■
EXAM_NRA_PRA
Negative/Positive Relative
Accommodation
Binocular
EXAM_OCULAR_HISTORY
Ocular history
PFSH
■
EXAM_METHOD
NRA/PRA:
NRA Blur: D.S. Recovery: D.S.
PRA Blur: D.S. Recovery: D.S.
■
■
OCULAR HISTORY:
■
Myopia
EXAM_PACHYMETRY
Pachymetry findings applied
to glaucoma risk assessment Test
[Yes/No/Unknown]
EXAM_PATIENT_ID
Patient ID [unique identifier
for the patient profile
specified for the exam]
Test
123
■
EXAM_PATIENT_TYPE_FLAG
Patient type
[Established/New]
Summary
New
■
EXAM_PD
Pupilary distance
Refractive
PD FAR:
OD: 32.00 OS: 32.00 OU: 64.00
PD NEAR:
OD: 30.50 OS: 30.50 OU: 61.00
■
EXAM_PHORIAS
Measurement of distant
horizontal phoria position
Binocular
EXAM_PHYSICIAN
Exam physician
Summary
Dr. Herman Snellen, OD
■
EXAM_PHYSICIAN_ADDRESSLINE
Exam physician's street
address
7700 N Kendall Dr, Suite 300
■
EXAM_PHYSICIAN_CITYSTATEZIP
Exam physician's city, state
and zip
Miami, FL 33156
■
EXAM_PHYSICIAN_FAX
Exam physician's fax number
(954) 393-2020
■
EXAM_PHYSICIAN_PHONE
Exam physician's phone
number
(954) 393-2020
■
EXAM_PHYSICIAN_REFERRED_BY
Referring physician
Summary
Dr. Sigmund Freud, MD
■
EXAM_PHYSICIAN_REFERRED_TO
Physician to whom the
patient is being referred
Assessment
Dr. Arthur C. Doyle, MD
■
EXAM_PHYSICIAN_REFERRED_TO_ADDRESSLINE
Street address of the
physician to whom the
patient is being referred
3050 Universal Blvd
■
EXAM_PHYSICIAN_REFERRED_TO_CITYSTATEZIP
City, state and zip of the
physician to whom the
patient is being referred
Weston, FL 33331
■
EXAM_PHYSICIAN_REFERRED_TO_FAX
Fax of the physician to whom
the patient is being referred
(954) 444-4444
■
EXAM_PHYSICIAN_REFERRED_TO_PHONE
Phone number of the
physician to whom the
patient is being referred
(954) 555-5555
■
EXAM_PLAN_EXAM
Plan notes for the exam
Assessment
PLAN:
Fit for daily wear lenses. Use spectacles prn Pt to
return within 1 wk for cl followup and dilation.
■
EXAM_PROCEDURES
Description of exam
procedures
Assessment
PROCEDURE(S):
EXAM; COMPREHENSIVE, NEW PATIENT
FITTING CL FOR TREATMENT OF DISEASE
■
■
HORZ: DIST:
■
3
Patient
Rx
Location
Order
Description
Calendar
Exam
Field Name
Example
EXAM_PUPILS
Pupils
Entrance
PUPILS:
OD: PERRLA OS: PERRLA
EXAM_PURSUITS
Pursuits
Binocular
PURSUITS:
OD: Smooth OS: Smooth
EXAM_RECALL_1
Recall date 1
Assessment
FOLLOW UP:
05/05/2010 for 6 Months
■
EXAM_RECALL_2
Recall date 2
Assessment
11/05/2015 for 6 Months
■
EXAM_RECALL_DT_DDMMYYYY
Recall date 1 [d/m/yyyy]
Assessment
31/12/2010
■
EXAM_RECALL_DT_MMDDYYYY
Recall date 1 [m/d/yyyy]
Assessment
12/31/2010
■
EXAM_RECALL_DT2_DDMMYYYY
Recall date 2 [d/m/yyyy]
Assessment
31/12/2010
■
EXAM_RECALL_DT2_MMDDYYYY
Recall date 2 [m/d/yyyy]
Assessment
12/31/2010
■
EXAM_RECALL_REASON
Recall 1 reason
Assessment
6 Months
■
EXAM_RECALL_REASON2
Recall 2 reason
Assessment
6 Months
■
EXAM_RECALLMONTHS
Recall 1 months
Assessment
6
■
EXAM_RECALLMONTHS2
Recall 2 months
Assessment
12
■
EXAM_REFERRING_PHYSICIAN
Referring physician name
Summary
WALTER REED MD
■
EXAM_REFERRING_PHYSICIAN_ADDRESSLINE
Referring physician address
6900 GEORGIA AVE, NW
■
EXAM_REFERRING_PHYSICIAN_CITYSTATEZIP
Referring physician city, state
and zip
WASHINGTON , DC 203070001
■
EXAM_REFERRING_PHYSICIAN_FAX
Referring physician fax
(202) 782-8000
■
EXAM_REFERRING_PHYSICIAN_PHONE
Referring physician phone
(202) 782-6000
■
EXAM_REFERRAL_REASON
Referral reason
Assessment
LASIK surgery referral
■
EXAM_ROS_COPY_EXAM_DT_DDMMYYYY
Review of systems (ROS)
copied from [d/m/yyyy]
ROS
31/12/2010
■
EXAM_ROS_COPY_EXAM_DT_MMDDYYYY
Review of systems (ROS)
copied from [m/d/yyyy]
ROS
12/31/2010
■
■
■
EXAM_ROS_DETAIL
Review of systems (ROS)
details
ROS
General/Constitutional: Negative
Ears/Nose/Mouth/Throat: Negative
Cardiovascular: Negative
Respiratory: Asthma
Gastrointestinal: Negative
Genitourinary: Negative
Musculoskeletal: Negative
Integumentary: Negative
Neurological: Negative
Psychiatric: Nervousness
Endocrine: Negative
Lymphatic/Hematological: Negative
Allergic/Immunologic: Penicillin
EXAM_ROS_MENTAL_HEADFACE
Headface
ROS
HEADFACE:
Normal
■
EXAM_ROS_MENTAL_MOOD
Mood
ROS
MOOD:
Agitated
■
EXAM_ROS_MENTAL_ORIENTATION
Mental orientation
ROS
ORIENTATION:
Disoriented
■
EXAM_ROS_NOTE_ADDITIONAL
Review of systems (ROS)
notes
ROS
EXAM_ROS_STATUS
Review of systems (ROS)
status
ROS
EXAM_SACCADES
Saccades
Binocular
EXAM_SIGNATURE_DT_DDMMYYYY
Date when the exam was
signed [m/d/yyyy]
Assessment
31/12/2010
■
EXAM_SIGNATURE_DT_MMDDYYYY
Date when the exam was
signed [d/m/yyyy]
Assessment
12/31/2010
■
EXAM_SIGNATURE_IMAGE
Examining doctor's signature
Assessment
image
SIGNATURE IMAGE
■
EXAM_SLENS_AUTOREFRACTOR
Autorefractor reading
■
STATUS:
History Exists
■
Refractive
EXAM_SLENS_FINAL
Final spectacle lens
prescription
Refractive
EXAM_SLENS_FINAL_NOTES
Final spectacle lens
prescription notes
Refractive
■
■
FINAL SPECTACLE RX:
OD: -0.50 D.S. DVA: 20/20 NVA: 20/20 OS: -0.75
D.S. DVA: 20/20 NVA: 20/20
■
■
Patient
Rx
Location
Order
Description
Calendar
Exam
Field Name
Example
EXAM_SLENS_MANIFEST
Manifest refraction
Refractive
MANIFEST:
OD: -0.50 D.S. DVA: 20/20 NVA: 20/20 OS: -0.75
D.S. DVA: 20/20 NVA: 20/20
■
EXAM_SLENS_PRESENTING
Presenting spectacle lens
prescription
Refractive
SPECTACLE RX:
OD: -0.50 D.S. DVA: 20/20 NVA: 20/20 OS: -0.50
D.S. DVA: 20/25 NVA: 20/25
■
EXAM_SLENS_RETINOSCOPY
Retinoscopy
Refractive
RETINOSCOPY:
OD: -0.50 D.S. DVA: 20/20 NVA: 20/20 OS: -0.50
D.S. DVA: 20/25 NVA: 20/25
■
EXAM_SOCIAL_HISTORY_ALCOHOL
Alcohol use
PFSH
Denies
■
■
EXAM_SOCIAL_HISTORY
Social history
PFSH
SOCIAL HISTORY:
Tobacco: Denies
Drugs: Denies
Alcohol: Denies
Other: Denies
EXAM_SOCIAL_HISTORY_DRUGS
Drugs use
PFSH
Denies
■
EXAM_SOCIAL_HISTORY_OTHER
Other social history factors
PFSH
Denies
■
EXAM_SOCIAL_HISTORY_TOBACCO
Tobacco use
PFSH
Denies
■
■
EXAM_STEROPSIS
Steropsis dist
Entrance
DIST:
121
EXAM_STEROPSIS_NEAR
Steropsis near
Entrance
NEAR:
78
■
Tests
EXAM PROCEDURES:
FB Corneal Eye: OD
■
■
EXAM_TEST_PROCEDURES
Test procedures
EXAM_TEST_TESTS
Tests performed
Tests
EXAM TESTS:
Corneal Pachymetry Ordered: Yes Tested: Yes
Findings: OD: central corneal thickness OD was thick, central
corneal thickness OS was thin OS: central corneal thickness
OD was thick, central corneal thickness OS was thin
Plan: thickness not enough to consider refractive surgery
EXAM_TIME_SPENT_COUNSELLING
Time spent counselling
Assessment
15
■
EXAM_TIME_SPENT_ON_EXAM
Time spent on exam
Assessment
30
■
EXAM_TIME_SPENT_WITH_DOCTOR
Time spent with doctor
Assessment
10
■
UNAIDED ACUITIES:
OD: DVA: 20/100 NVA: 20/20 PH: 20/20
OS: DVA: 20/80 NVA: 20/20 PH: 20/20
OU: DVA: 20/70 NVA: 20/20 PH: 20/20
■
EXAM_UNAIDEDVA
Unaided visual accuities
Refractive
EXAM_VERGENCE_BD
Vergence Base-Down
Binocular
■
EXAM_VERGENCE_BI
Vergence Base-In
Binocular
■
EXAM_VERGENCE_BO
Vergence Base-Out
Binocular
■
EXAM_VERGENCE_BU
Vergence Base-Up
Binocular
■
EXAM_VERSIONS
Versions
Binocular
VERSIONS:
Smooth and full
EXAM_VISUAL_ACUITY_UNAIDED_OD_DIST
OD: Unaided distant visual
accuity
Refractive
20/100
■
EXAM_VISUAL_ACUITY_UNAIDED_OD_NEAR
OD: Unaided near visual
accuity
Refractive
20/20
■
EXAM_VISUAL_ACUITY_UNAIDED_OD_PINHOLE
OD: Unaided pinhole visual
accuity
Refractive
20/20
■
EXAM_VISUAL_ACUITY_UNAIDED_OS_DIST
OS: Unaided distant visual
accuity
Refractive
20/80
■
EXAM_VISUAL_ACUITY_UNAIDED_OS_NEAR
OS: Unaided near visual
accuity
Refractive
20/20
■
EXAM_VISUAL_ACUITY_UNAIDED_OS_PINHOLE
OS: Unaided pinhole visual
accuity
Refractive
20/20
■
EXAM_VISUAL_ACUITY_UNAIDED_OU_DIST
OU: Unaided distant visual
accuity
Refractive
20/70
■
EXAM_VISUAL_ACUITY_UNAIDED_OU_NEAR
OU: Unaided near visual
accuity
Refractive
20/20
■
EXAM_VISUAL_ACUITY_UNAIDED_OU_PINHOLE
OU: Unaided pinhole visual
accuity
Refractive
20/20
■
OD:
Intact peiphery in area of white w/pressure
■
EXAM_VISUAL_FIELDS_OD
OD: Visual field observations Test
■
Patient
Rx
Location
Order
Description
Calendar
Exam
Field Name
Example
Patient
Rx
Location
Order
Description
Calendar
Exam
Field Name
EXAM_VISUAL_FIELDS_OS
OS: Visual field observations Test
OS:
Same as OD
■
EXAM_VISUAL_FIELDS_RESULT
Visual fields result
Test
RESULT:
Testing was reliable
■
EXAM_VISUAL_FIELDS_TYPE
Visual fields type
Test
Confrontation
■
LENS_MATERIAL
Lens material
Lens
CR 39
MYCOMPANYINFORMATION_ADDRESSLINE
Street address for the
location in use
7700 N Kendall Drive, Suite 300
■ ■ ■ ■ ■
MYCOMPANYINFORMATION_CITY
City of the location in use
Miami
■ ■ ■ ■ ■
MYCOMPANYINFORMATION_COMPANY_CODE
Company code of the
location in use
MVE
■ ■ ■ ■ ■
MYCOMPANYINFORMATION_COMPANYNAME
Company name of the
location in use
My Vision Eyecare
■ ■ ■ ■ ■
MYCOMPANYINFORMATION_EMAILNAME
Email address of the location
in use
[email protected]
■ ■ ■ ■ ■
MYCOMPANYINFORMATION_FAXNUMBER
Fax number for the location
in use [(000) 000-0000]
(877) 882-7455
■ ■ ■ ■ ■
MYCOMPANYINFORMATION_PHONENUMBER
Phone number for the
location in use [(000) 0000000]
(877) 882-7456
■ ■ ■ ■ ■
MYCOMPANYINFORMATION_STATE
State of the location in use
FL
■ ■ ■ ■ ■
MYCOMPANYINFORMATION_TAXNUMBER
Tax ID number of the location
in use [00-0000000]
47-0938321
■ ■ ■ ■ ■
MYCOMPANYINFORMATION_WEBSITE
Website for the location in
use
www.myvisioneyecare.com
■ ■ ■ ■ ■
MYCOMPANYINFORMATION_ZIPCODE
Zip code for the location in
use [00000-0000]
33156-0000
■ ■ ■ ■ ■
ORDER_STATUS
Order status
Payments
At Lab
■
ORDERS_A
Frame's A measurement
Frame
44.6
■
ORDERS_B
Frame's B measurement
Frame
34.6
■
ORDERS_BRIDGE
Frame's bridge
Frame
18
■
ORDERS_CHARGES
Order charges
Frame
100
■
ORDERS_COLLECTION
Frame's collection
Frame
Calvin Klein
■
ORDERS_COLOR
Frame's color
Frame
522
■
ORDERS_COLOR_NUMBER
Frame's color number
Frame
02F2
■
ORDERS_DIAGNOSIS_1
Order's diagnosis 1
Prescriptions
367.1
■
ORDERS_DIAGNOSIS_2
Order's diagnosis 2
Prescriptions
■
ORDERS_DIAGNOSIS_3
Order's diagnosis 3
Prescriptions
■
ORDERS_DIAGNOSIS_4
Order's diagnosis 4
Prescriptions
■
ORDERS_DIAGNOSIS_DESCRIPTION_1
Order's diagnosis description
Prescriptions
1
ORDERS_DIAGNOSIS_DESCRIPTION_2
Order's diagnosis description
Prescriptions
2
■
ORDERS_DIAGNOSIS_DESCRIPTION_3
Order's diagnosis description
Prescriptions
3
■
ORDERS_DIAGNOSIS_DESCRIPTION_4
Order's diagnosis description
Prescriptions
4
■
ORDERS_ED
Frame's effective diameter
(ED)
Frame
44.9
■
ORDERS_EYE
Frame's eye size
Frame
45
■
ORDERS_FRAME
Frame's name
Frame
CK115
■
ORDERS_FRAME_NOTES
Frame's notes
Frame
ORDERS_FRAME_TYPE
Frame's type
Frame
Metal
■
ORDERS_FRAME_USAGE
Frame's usage
Frame
Dress
■
ORDERS_GENDER
Frame's gender
Frame
Unisex
■
ORDERS_INSURANCE_BALANCE
Order's insurance balance
Invoice
0
■
ORDERS_INSURANCE_DUE
Order's insurance due
Invoice
0
■
ORDERS_INSURANCE_PAYMENTS
Order's insurance payments
Invoice
0
■
Myopia
■
■
■
Example
ORDERS_LAB_NAME
Order's lab name
Invoice
ORDERS_LENS_COLOR
Order's lens color
Invoice
■
ORDERS_MANUFACTURER
Frame's manufacturer
Frame
Marchon
■
ORDERS_MATERIAL
Frame's material
Frame
Metal
■
ORDERS_NOTES
Order's notes
Patient
■
ORDERS_OD_ADD
OD: Spectacle lens add
Lens
■
ORDERS_OD_AXIS
OD: Spectacle lens axis
Lens
■
ORDERS_OD_BASE
OD: Spectacle lens base
[In/Out]
Lens
■
ORDERS_OD_BASE_UD
OD: Spectacle lens base
[Up/Down]
Lens
■
ORDERS_OD_BC
OD: Spectacle lens base
curve
Lens
ORDERS_OD_CYLINDER
OD: Spectacle lens cylinder
Lens
ORDERS_OD_DEC
OD: Spectacle lens
decentration
Lens
ORDERS_OD_INSET
OD: Spectacle lens inset
Lens
ORDERS_OD_LENS_STYLE
OD: Spectacle lens lens style Lens
ORDERS_OD_OC_HT
OD: Spectacle lens OC
height
Lens
ORDERS_OD_PD_FAR
OD: Spectacle lens PD far
Lens
32
■
ORDERS_OD_PD_NEAR
OD: Spectacle lens PD near
Lens
30.5
■
ORDERS_OD_PRISM
OD: Spectacle lens prism
Lens
■
ORDERS_OD_SEGHT
OD: Spectacle lens segment
height
Lens
■
ORDERS_OD_SPHERE
OD: Spectacle lens sphere
Lens
ORDERS_OD_TOTAL_DEC
OD: Spectacle lens total
decentration
Lens
ORDERS_ORDER_TYPE
Order type [Spectacle
Lens/Frame Only/Soft
Contact/Hard Contact/Other]
Spectacle Lens
■
ORDERS_ORDERDATE
Order date [d-Mmm-yy]
13-Sep-10
■
ORDERS_ORDERDATE_MMDDYY
Orders orderdate [mdyy]
91310
■
ORDERS_ORDERID
Order ID [incremental unique
identifier assigne by the
database to each order]
116
■
ORDERS_OS_ADD
OS: Spectacle lens add
Lens
■
ORDERS_OS_AXIS
OS: Spectacle lens axis
Lens
■
ORDERS_OS_BASE
OS: Spectacle lens base
[In/Out]
Lens
■
ORDERS_OS_BASE_UD
OS: Spectacle lens base
[Up/Down]
Lens
■
ORDERS_OS_BC
OS: Spectacle lens base
curve
Lens
■
ORDERS_OS_CYLINDER
OS: Spectacle lens cylinder
Lens
ORDERS_OS_DEC
OS: Spectacle lens
decentration
Lens
ORDERS_OS_INSET
OS: Spectacle lens inset
Lens
ORDERS_OS_LENS_STYLE
OS: Spectacle lens lens style Lens
ORDERS_OS_OC_HT
OS: Spectacle lens OC
height
Lens
ORDERS_OS_PD_FAR
OS: Spectacle lens PD far
Lens
32
■
ORDERS_OS_PD_NEAR
OS: Spectacle lens PD near
Lens
30.5
■
ORDERS_OS_PRISM
OS: Spectacle lens prism
Lens
ORDERS_OS_SEGHT
OS: Spectacle lens segment
height
Lens
ORDERS_OS_SPHERE
OS: Spectacle lens sphere
Lens
■
■
D.S.
■
■
■
Single Vision
■
■
PL
■
■
D.S.
■
■
■
Single Vision
■
■
■
■
PL
■
Patient
Rx
Location
Order
Description
Calendar
Exam
Field Name
Example
Patient
Rx
Location
Order
Description
Calendar
Exam
Field Name
ORDERS_OS_TOTAL_DEC
OS: Spectacle lens total
decentration
Lens
ORDERS_OU_PD_FAR
OU: Spectacle lens PD far
Lens
61
■
ORDERS_OU_PD_NEAR
OU: Spectacle lens PD near
Lens
64
■
ORDERS_PATIENT_BALANCE
Patient balance for the order
0
■
ORDERS_PATIENT_DUE
Patient total for the order
100
■
ORDERS_PATIENT_PAYMENTS
Total of patient payments for
the order
100
■
ORDERS_PAYMENTS
Total of payments (insurance
and patient) for the order
100
■
ORDERS_PHYSICIAN
Last name of the physician
Snellen
■
ORDERS_PHYSICIAN_DEA
Physician's DEA number
■
ORDERS_PHYSICIAN_LICENSE
Physician's license number
■
ORDERS_PHYSICIAN_NPI
Physician's NPI number
■
ORDERS_PHYSICIAN_UPIN
Physician's UPIN
■
ORDERS_PHYSICIAN_UPPER_NAME
Physician's name
[uppercase]
ORDERS_PROMISED_DATE
Promised date
ORDERS_RIM_TYPE
Frame's rim type
ORDERS_SHAPE
Frame's shape
■
ORDERS_TEMPLE_LENGTH
Frame's temple length
■
PATIENT_ADDRESSLINE
Street address for the patient
[PATIENT_address line 1 + ",
" + PATIENT_address line 2]
1300 Komodo Dragon Isle 2, Ste 300
■
PATIENT_ADDRESSLINE1
Patient's street address (line
1)
1300 Komodo Dragon Isle 2
■ ■ ■ ■ ■
PATIENT_ADDRESSLINE2
Patient's street address (line
2)
Ste 300
■ ■ ■ ■ ■
PATIENT_AGE
Age of the patient in years
110
■ ■ ■ ■ ■
PATIENT_ALLERGIES
Allergies in PFSH
ALLERGIES:
Penicillin
PATIENT_BIRTHDATE
Patient's date of birth [dMmm-yy]
1-Jan-00
PATIENT_BIRTHDATE_MMDDYYYY
Patient's date of birth [mdyy]
1011900
PATIENT_CELLULARPHONE
Patient's mobile phone
number [(000) 000-0000]
(777) 777-7777
■
PATIENT_CITY
Patient's city
Weston
■ ■ ■ ■ ■
PATIENT_COUNTRY
Patient's country
United States
PATIENT_DATEENTERED
Date when the patient profile
was created [d-Mmm-yy]
27-Feb-08
■ ■ ■ ■ ■
PATIENT_EMAILNAME
Patient's email address
[email protected]
■ ■ ■ ■
PATIENT_EMPLOYERADDRESSLINE
Street address of the
patient's employer
1836 Galapagos Is Dr
■ ■ ■ ■ ■
PATIENT_EMPLOYERCITY
City of the patient's employer
Fort Lauderdale
■ ■ ■ ■
PATIENT_EMPLOYERNAME
Name of the patient's
employer
HMS Beagle
■ ■ ■ ■ ■
PATIENT_EMPLOYERPHONE
Phone number for the
patient's employer [(000)
000-0000]
(800) 2EV-OLVE
■
PATIENT_EMPLOYERSTATE
State of the patient's
employer
FL
■ ■ ■ ■ ■
PATIENT_EMPLOYERZIP
Zip code of the patient's
employer [00000-0000]
33331
■ ■ ■ ■ ■
PATIENT_EMPLOYMENT_STATUS
Patient's employment status
Retired
PATIENT_FAXNUMBER
Fax number for the patient
[(000) 000-0000]
(954) 562-6666
■
PATIENT_FIRSTNAME
First name of the patient
Charles
■ ■ ■ ■ ■
PATIENT_GUARANTOR_ADDRESSLINE1
Street address line 1 of
guarantor
1300 Komodo Dragon Isle 2
■
■
DR. HERMAN SNELLEN
■
■
Rimless
PFSH
■
■ ■ ■
■
■ ■ ■ ■ ■
■
■
■ ■ ■
■
■ ■ ■
■ ■
Example
Patient
Rx
Location
Order
Description
Calendar
Exam
Field Name
PATIENT_GUARANTOR_ADDRESSLINE2
Street address line 2 of
guarantor
Ste 300
■
■ ■
PATIENT_GUARANTOR_BIRTHDATE
Guarantor's date of birth [dMmm-yy]
1-Jan-00
■
■ ■
PATIENT_GUARANTOR_CITY
Guarantor's city
Weston
■
■ ■
PATIENT_GUARANTOR_HOMEPHONE
Guarantor's home phone
number [(000) 000-0000]
(555) 555-5555
■
■ ■
PATIENT_GUARANTOR_NAME_FULL
Guarantor's full name
Mrs. Emma Darwin
■
■ ■
PATIENT_GUARANTOR_RELATIONSHIP
Guarantor's relationship to
patient
Spouse
■
■ ■
PATIENT_GUARANTOR_SEX
Guarantor's gender
[Male/Female]
Female
■
■ ■
PATIENT_GUARANTOR_SSN
Guarantor's Social Security
Number [000-00-0000]
987-65-4321
■
■ ■
PATIENT_GUARANTOR_STATE
Guarantor's state
FL
■
■ ■
PATIENT_GUARANTOR_WORKPHONE
Guarantor's work phone
number [(000) 000-0000]
(555) 555-5555
■
■ ■
PATIENT_GUARANTOR_ZIPCODE
Guarantor's zip code [000000000]
33331-0000
■
■ ■
PATIENT_HOMEPHONE
Patient's home phone
number [(000) 000-0000]
(555) 555-5555
■
■ ■ ■
PATIENT_INSURANCE_DENTAL_PRIMARY_NOTE
Notes regarding the patient's
primary dental insurance
■
PATIENT_INSURANCE_DENTAL_SECONDARY_NOTE
Notes regarding the patient's
secondary dental insurance
■
PATIENT_INSURANCE_MEDICAL_FIFTH_COMPANY
Fifth medical insurance
company
■
PATIENT_INSURANCE_MEDICAL_FIFTH_ID
Fifth medical insurance ID
number
■
PATIENT_INSURANCE_MEDICAL_FIFTH_POLICYGROUP
Fifth medical insurance group
number
■
PATIENT_INSURANCE_MEDICAL_FOURTH_COMPANY
Fourth medical insurance
company
■
PATIENT_INSURANCE_MEDICAL_FOURTH_ID
Fourth medical insurance ID
number
■
PATIENT_INSURANCE_MEDICAL_FOURTH_POLICYGRO Fourth medical insurance
UP
group number
PATIENT_INSURANCE_MEDICAL_PRIMARY_COMPANY
Company name of the
primary medical insurance for
the patient
PATIENT_INSURANCE_MEDICAL_PRIMARY_ID
Primary medical insurance ID
number
PATIENT_INSURANCE_MEDICAL_PRIMARY_NOTE
Notes regarding the primary
medical insurance for the
patient
PATIENT_INSURANCE_MEDICAL_PRIMARY_POLICYGR
OUP
Primary medical insurance
group number
■
■
■
■
■
■
Company name of the
PATIENT_INSURANCE_MEDICAL_SECONDARY_COMPA
secondary medical insurance
NY
for the patient
PATIENT_INSURANCE_MEDICAL_SECONDARY_ID
Secondary medical insurance
ID number
PATIENT_INSURANCE_MEDICAL_SECONDARY_NOTE
Notes regarding the
secondary medical insurance
for the patient
■
■
■
■
PATIENT_INSURANCE_MEDICAL_SECONDARY_POLICY Secondary medical insurance
GROUP
group number
■
Company name of the
PATIENT_INSURANCE_MEDICAL_TERTIARY_COMPANY tertiary medical insurance for
■
■
the patient
PATIENT_INSURANCE_MEDICAL_TERTIARY_ID
Tertiary medical insurance ID
number
■
Example
PATIENT_INSURANCE_MEDICAL_TERTIARY_POLICYGR Tertiary medical insurance
OUP
group number
Patient
Rx
Location
Order
Description
Calendar
Exam
Field Name
■
PATIENT_INSURANCE_OTHER_FIFTH_COMPANY
Fifth other insurance
company
■
PATIENT_INSURANCE_OTHER_FIFTH_ID
Fifth other insurance ID
number
■
PATIENT_INSURANCE_OTHER_FIFTH_POLICYGROUP
Fifth other insurance group
number
■
PATIENT_INSURANCE_OTHER_FOURTH_COMPANY
Fourth other insurance
company
■
PATIENT_INSURANCE_OTHER_FOURTH_ID
Fourth other insurance ID
number
■
PATIENT_INSURANCE_OTHER_FOURTH_POLICYGROU
P
Fourth other insurance group
number
■
PATIENT_INSURANCE_OTHER_PRIMARY_COMPANY
Primary other insurance
company
■
PATIENT_INSURANCE_OTHER_PRIMARY_ID
Primary other insurance ID
number
■
PATIENT_INSURANCE_OTHER_PRIMARY_ID
Primary other insurance ID
number
■
PATIENT_INSURANCE_OTHER_PRIMARY_NOTE
Notes regarding the primary
other insurance for the
patient
PATIENT_INSURANCE_OTHER_PRIMARY_POLICYGRO
UP
Primary other insurance
group number
PATIENT_INSURANCE_OTHER_SECONDARY_NOTE
Notes regarding the
secondary other insurance
for the patient
PATIENT_INSURANCE_OTHER_SECONDARY_POLICYG
ROUP
Secondary other insurance
group number
■
PATIENT_INSURANCE_OTHER_TERTIARY_COMPANY
Tertiary other insurance
company
■
PATIENT_INSURANCE_OTHER_TERTIARY_ID
Tertiary other insurance ID
number
■
■
■
■
PATIENT_INSURANCE_OTHER_TERTIARY_POLICYGRO Tertiary other insurance
UP
group number
■
PATIENT_INSURANCE_SEC_RELATION
Patient relationship to
insured party for secondary
vision insurance
■
PATIENT_INSURANCE_VISION_FIFTH_COMPANY
Fifth vision insurance
company
■
PATIENT_INSURANCE_VISION_FIFTH_ID
Fifth vision insurance ID
number
■
PATIENT_INSURANCE_VISION_FIFTH_POLICYGROUP
Fifth vision insurance group
number
■
PATIENT_INSURANCE_VISION_FOURTH_COMPANY
Fourth vision insurance
company
■
PATIENT_INSURANCE_VISION_FOURTH_ID
Fourth vision insurance ID
number
■
PATIENT_INSURANCE_VISION_FOURTH_POLICYGROU
P
Fourth vision insurance
group number
■
PATIENT_INSURANCE_VISION_PRIMARY
Primary vision insurance
company
VSP
PATIENT_INSURANCE_VISION_PRIMARY_BIRTHDATE
Primary vision insurance date
of birth of insured party
[Mmm d, yyyy]
Jan 01, 1900
PATIENT_INSURANCE_VISION_PRIMARY_CO
Company name of the
primary vision insurance for
the patient
VSP
PATIENT_INSURANCE_VISION_PRIMARY_COMPANY
Primary vision insurance
company
VSP
■ ■
PATIENT_INSURANCE_VISION_PRIMARY_EMPLOYER
Primary vision insurance
employer of insured party
HMS Beagle
■
■
■
■
Patient's primary vision
insurance ID number
Example
360136101
■
PATIENT_INSURANCE_VISION_PRIMARY_INSURED_BIR Date of birth of the primary
THDATE
vision insured party
1-Jan-00
■
PATIENT_INSURANCE_VISION_PRIMARY_INSURED_EM Employer of the primary
PLOYER
vision insured party
HMS Beagle
■
PATIENT_INSURANCE_VISION_PRIMARY_INSURED_NA Name of the primary vision
ME
insured party
Charles Darwin
■
PATIENT_INSURANCE_VISION_PRIMARY_ID
PATIENT_INSURANCE_VISION_PRIMARY_INSURED_SE
X
Gender of the primary vision
insured party
Male
■
PATIENT_INSURANCE_VISION_PRIMARY_INSURED_ST
ATE
State of the primary vision
insured party
FL
■
33331-0000
■
No allowance for contacts
■
12345
■
Patient
Rx
Location
Order
Description
Calendar
Exam
Field Name
■ ■
■
Zip code of the primary vision
PATIENT_INSURANCE_VISION_PRIMARY_INSURED_ZIP insured party
[00000-0000]
PATIENT_INSURANCE_VISION_PRIMARY_NOTE
Notes regarding the primary
vision insurance for the
patient
PATIENT_INSURANCE_VISION_PRIMARY_POLICYGROU Group number for the
P
primary vision insurance plan
■ ■ ■
PATIENT_INSURANCE_VISION_PRIMARY_RELATION
Primary vision insurance
relation of insured party
Self
PATIENT_INSURANCE_VISION_PRIMARY_RELATION
Primary vision insured party's
relationship to the patient
Self
PATIENT_INSURANCE_VISION_PRIMARY_SEX
Primary vision insurance sex
of insured party
Male
■
PATIENT_INSURANCE_VISION_PRIMARY_STATE
Primary vision insurance
state of insured party
FL
■
PATIENT_INSURANCE_VISION_PRIMARY_ZIP
Primary vision insurance zip
of insured party
33331
■
PATIENT_INSURANCE_VISION_SEC_CO
Company name of the
secondary vision insurance
for the patient
■
PATIENT_INSURANCE_VISION_SEC_DOB
Date of birth of the secondary
vision insured party
■
PATIENT_INSURANCE_VISION_SEC_EMPLOYER
Employer of the secondary
vision insured party
■
PATIENT_INSURANCE_VISION_SEC_ID
Patient's secondary vision
insurance ID number
■
PATIENT_INSURANCE_VISION_SEC_NAME_FULL
Name of the secondary
vision insured party
■
PATIENT_INSURANCE_VISION_SEC_NOTE
Notes regarding the
secondary vision insurance
for the patient
■
PATIENT_INSURANCE_VISION_SEC_POLICYGP
Group number for the
secondary vision insurance
plan
■
PATIENT_INSURANCE_VISION_SEC_RELATION
Secondary vision insured
party's relationship to the
patient
■
PATIENT_INSURANCE_VISION_SEC_SSN
Social Security Number of
the secondary vision insured
party [000-00-0000]
■
PATIENT_INSURANCE_VISION_SECONDARY_COMPAN
Y
Secondary vision insurance
company
■
PATIENT_INSURANCE_VISION_SECONDARY_DOB
Secondary vision insurance
date of birth of insured party
■
PATIENT_INSURANCE_VISION_SECONDARY_EMPLOYE Secondary vision insurance
R
employer of insured party
■
Secondary vision insurance
ID number
■
PATIENT_INSURANCE_VISION_SECONDARY_NAME_FU Secondary vision insurance
LL
name of insured party
■
PATIENT_INSURANCE_VISION_SECONDARY_ID
■
■
Example
Patient
Rx
Location
Order
Description
Calendar
Exam
Field Name
PATIENT_INSURANCE_VISION_SECONDARY_POLICYG
ROUP
Secondary vision insurance
group number
■
PATIENT_INSURANCE_VISION_SECONDARY_SSN
Secondary vision insurance
SSN of insured party
■
PATIENT_INSURANCE_VISION_TERTIARY_COMPANY
Tertiary vision insurance
company
■
PATIENT_INSURANCE_VISION_TERTIARY_ID
Tertiary vision insurance ID
number
■
PATIENT_INSURANCE_VISION_TERTIARY_POLICYGRO
UP
Tertiary vision insurance
group number
■
PATIENT_INSURANCE_VISIONMEDICAL_FIFTH_COMPA
NY
Fifth vision/medical insurance
company
■
PATIENT_INSURANCE_VISIONMEDICAL_FIFTH_ID
Fifth vision/medical insurance
ID number
■
PATIENT_INSURANCE_VISIONMEDICAL_FIFTH_POLICY
GROUP
Fifth vision/medical insurance
group number
■
PATIENT_INSURANCE_VISIONMEDICAL_FOURTH_COM
PANY
Fourth vision/medical
insurance company
■
PATIENT_INSURANCE_VISIONMEDICAL_FOURTH_ID
Fourth vision/medical
insurance ID number
■
PATIENT_INSURANCE_VISIONMEDICAL_FOURTH_POLI
CYGROUP
Fourth vision/medical
insurance group number
■
PATIENT_INSURANCE_VISIONMEDICAL_PRIMARY_CO
MPANY
Primary vision/medical
insurance company
■
PATIENT_INSURANCE_VISIONMEDICAL_PRIMARY_ID
Primary vision/medical
insurance ID number
■
Notes regarding the primary
PATIENT_INSURANCE_VISIONMEDICAL_PRIMARY_NOT
vision/medical insurance for
E
■
the patient
PATIENT_INSURANCE_VISIONMEDICAL_PRIMARY_POLI Primary vision/medical
CYGROUP
insurance group number
PATIENT_INSURANCE_VISIONMEDICAL_SECONDARY_
COMPANY
Secondary vision/medical
insurance company
PATIENT_INSURANCE_VISIONMEDICAL_SECONDARY_I Secondary vision/medical
D
insurance ID number
■
ADVANTRA FREEDOM
■
123456789
■
PATIENT_INSURANCE_VISIONMEDICAL_SECONDARY_
NOTE
Notes regarding the
secondary vision/medical
insurance for the patient
PATIENT_INSURANCE_VISIONMEDICAL_SECONDARY_
POLICYGROUP
Secondary vision/medical
insurance group number
PATIENT_INSURANCE_VISIONMEDICAL_TERTIARY_CO
MPANY
Tertiary vision/medical
insurance company
■
PATIENT_INSURANCE_VISIONMEDICAL_TERTIARY_ID
Tertiary vision/medical
insurance ID number
■
PATIENT_INSURANCE_VISIONMEDICAL_TERTIARY_PO
LICYGROUP
Tertiary vision/medical
insurance group number
■
PATIENT_LANGUAGES
Languages spoken by patient
English
PATIENT_LASTEXAMDATE
Date of the patient's last
examination [d-Mmm-yy]
7-Oct-10
■
PATIENT_LASTNAME
Last name of the patient
Darwin
■ ■ ■ ■ ■
PATIENT_LOCATION_ID
Location where the patient
was setup [unique identifier]
15
PATIENT_MARITAL_STATUS
Patient's marital status
Married
■
PATIENT_MIDDLENAME
Middle initial of the patient
R
■ ■ ■ ■ ■
PATIENT_NAME_FULL
Full patient name [title + first
name + middle initial + last
name + suffix]
Mr. Charles R. Darwin, Sr
■ ■ ■ ■ ■
PATIENT_NOTES
Patient profile notes
Patient notes
PATIENT_OCCUPATION
Patient's occupation
Naturalist
■ ■
PATIENT_PATIENTACTIVE
Flag indicating whether a
patient is active or not
[Yes/No]
Yes
■
■
5544645
■
■
■ ■ ■
■ ■
■
■
■
■ ■ ■
Example
Patient
Rx
Location
Order
Description
Calendar
Exam
Field Name
PATIENT_PATIENTID
Patient number [incremental
unique identifier
automatically assigned by the
database]
1001
PATIENT_PREFERRED_CONTACT_METHOD
Patient’s preferred contact
method
E-mail
PATIENT_PRIMARYINSURANCEID
Insurance ID for primary
vision
360136101
PATIENT_PROBLEMS_LIST
List of problems affecting the
Health
patient
PATIENT PROBLEM LIST:
Foreign Body, Corneal, ICD: 930.0, Active, 06/07/2011
Astigmatism, High Myopia Additional comments., ICD: ,
Eye: NA , 01/25/2011
PATIENT_RACE
Patient’s race
White
PATIENT_RECALLDATE
Date of the first patient's first
recall
28-Sep-11
PATIENT_RECALLDATE2
Date of the first patient's
second recall
Mar 28
, 2011
PATIENT_RECALLREASON
Reason for the first patient
recall
12 Months
■
PATIENT_RECALLREASON2
Reason for the seconde
patient recall
6 Months
■
■
PATIENT_REFERENCE
Patient's reference field
■
■ ■
PATIENT_REFERRAL_ADDRESS
Address line of patient's
referrer
3 Percival Terrace
■
■
PATIENT_REFERRAL_CITY
City of patient's referrer
Nunam Iqua
■
■
PATIENT_REFERRAL_NAME
Name of patient's referrer
Herbert Spencer
■
■
PATIENT_REFERRAL_PHONE
Phone number of patient's
referrer [0000000000]
9547878483
■
■
PATIENT_REFERRAL_STATE
State of patient's referrer
AK
■
■
PATIENT_REFERRAL_ZIP
Zip code of patient's referrer
[00000-0000]
99666
■
■
PATIENT_SENDMAIL
Flag indicating whether
marketing mailings should be
sent to the patient [Yes/No]
Yes
■
■ ■ ■
PATIENT_SEX
Patient gender [Male/Female]
Male
■ ■ ■ ■ ■
PATIENT_SMOKING_STATUS_CURRENT
Patient’s current smoking
status
Current everyday smoker
PATIENT_SSN
Patient's Social Security
Number [000-00-0000]
360-13-6101
■ ■ ■ ■ ■
PATIENT_STATEORPROVINCE
State where the patient lives
FL
■ ■ ■ ■ ■
PATIENT_SUFFIX
Patient's name suffix
Sr
■ ■ ■ ■ ■
PATIENT_SURGICAL_PROCEDURES
Surgical procedures
performed on the patient
PATIENT SURGICAL PROCEDURES:
Chalazion (minor procedure, in office)
PATIENT_TITLE
Patient's name title
Mr.
Patients blood pressure and
body mass index readings
PATIENT VITAL SIGNS:
01/20/2011, Age: 95.07, BP: 130/85, Pulse: 84, Height: 5ft
11in , Weight: 198.00lbs, BMI: 27.60
03/03/2010, Age: 94.19, BP: 120/80, Pulse: 85, Height: 5ft
11in , Weight: 200.00lbs, BMI: 27.90
PATIENT_VITAL_SIGNS
ROS
Health
■ ■ ■ ■ ■
■
■
■
■
■ ■ ■
■
■
■
■
■ ■ ■ ■ ■
■
PATIENT_WORK_PHONE_EXT
Patients work phone
extension
789
■
■
PATIENT_WORKPHONE
Patients work phone [(000)
000-0000]
(888) 888-8888
■
■ ■ ■
PATIENT_ZIPCODE
Patient's zip code
33331
■ ■ ■ ■ ■
PHYSICIAN_ADDRESSLINE1
Physician address line 1
3050 Universal Blvd
■
PHYSICIAN_ADDRESSLINE2
Physician address line 2
Ste 120
■
PHYSICIAN_CITY
Physician city
Weston
■
PHYSICIAN_FAX
Physician fax
8778827455
■
PHYSICIAN_LICENSENUMBER
Physician licensenumber
PHYSICIAN_PHONE
Physician phone
8778827456
■
PHYSICIAN_PHYSICIANNAME
Physician physicianname
Dr. Herman Snellen
■
PHYSICIAN_STATE
Physician state
FL
■
■
Example
Patient
Rx
Location
Order
Description
Calendar
Exam
Field Name
PHYSICIAN_ZIPCODE
Physician zipcode
33331
■
PRESCRIPTION_TYPE
Prescription type
Spectacle Lens
■
PRESCRIPTIONS_ADD_OD
OD: Spectacle lens add
■
PRESCRIPTIONS_ADD_OS
OS: Spectacle lens add
■
PRESCRIPTIONS_APPLICATION
Application
■
PRESCRIPTIONS_AXIS_OD
OD: Spectacle lens axis
■
PRESCRIPTIONS_AXIS_OS
OS: Spectacle lens axis
■
PRESCRIPTIONS_COMMENTS
Prescriptions comments
■
PRESCRIPTIONS_CYLINDER_OD
OD: Spectacle lens cylinder
■
PRESCRIPTIONS_CYLINDER_OS
OS: Spectacle lens cylinder
■
PRESCRIPTIONS_DISPENSE_AS_WRITTEN_FLAG
Prescriptions dispense as
written flag
■
PRESCRIPTIONS_DOSAGE
Dosage
■
PRESCRIPTIONS_DUPLICATION
Is prescription a duplication?
[Yes/No]
No
■
PRESCRIPTIONS_EXPIRYDATE
Prescription's expiration date
[Mmm d, yyyy]
Sep 29, 2009
■
PRESCRIPTIONS_FREQUENCY
Frequency
■
PRESCRIPTIONS_LENS_BC_CONTACT_OD
OD: Contact lens base curve
■
PRESCRIPTIONS_LENS_BC_CONTACT_OS
OS: Contact lens base curve
■
PRESCRIPTIONS_LENS_BC_OD
OD: Spectacle lens bc
■
PRESCRIPTIONS_LENS_BC_OS
OS: Spectacle lens bc
■
PRESCRIPTIONS_LENS_DIA_OD
OD: Spectacle lens dia
■
PRESCRIPTIONS_LENS_DIA_OS
OS: Spectacle lens dia
PRESCRIPTIONS_LENSMATERIAL
Lens material
PRESCRIPTIONS_LENSNAME_OD
OD: Lens name
■
PRESCRIPTIONS_LENSNAME_OS
OS: Lens name
■
PRESCRIPTIONS_LENSSTYLE
Lens style
■
PRESCRIPTIONS_LOCK_DATE
Lock date
■
PRESCRIPTIONS_LOCKED_FLAG
Is prescription locked?
[Yes/No]
PRESCRIPTIONS_MEDICATION
Medication name
■
PRESCRIPTIONS_MEDICATION_GROUP
Medication group
■
PRESCRIPTIONS_ODBASE
OD: Spectacle lens base
■
PRESCRIPTIONS_ODBASEUDTEXT
OD: Spectacle lens base
[Up/Down]
■
PRESCRIPTIONS_ODPRISM
OD: Spectacle lens prism
■
PRESCRIPTIONS_ODPRISMUD
OD: Spectacle lens prism
[Up/Down]
■
PRESCRIPTIONS_OSBASE
OS: Spectacle lens base
■
PRESCRIPTIONS_OSBASEUDTEXT
OS: Spectacle lens base
[Up/Down]
■
PRESCRIPTIONS_OSPRISM
OS: Spectacle lens prism
■
PRESCRIPTIONS_OSPRISMUD
OS: Spectacle lens prism
[Up/Down]
■
PRESCRIPTIONS_PRESCRIPTIONID
Prescription ID [incremental
unique identifier assigned by
the database to each
prescription]
PRESCRIPTIONS_QUANTITY
Prescription quantity
PRESCRIPTIONS_REFILLS
Prescription refills
PRESCRIPTIONS_REFILLSFILLED
Prescription refills filled
PRESCRIPTIONS_RELEASE_DATE
Prescription release date
[Mmm d, yyyy]
Sep 29, 2007
■
PRESCRIPTIONS_RELEASED_FLAG
Prescriptions released
[Yes/No]
No
■
■
Glass (Index <= 1.530)
No
1529
■
■
■
■
1
■
■
Example
Patient
Rx
Location
Order
Description
Calendar
Exam
Field Name
PRESCRIPTIONS_RXDATE
Prescription date [Mmm d,
yyyy]
Sep 29, 2007
■
PRESCRIPTIONS_SPHERE_OD
OD: Prescription sphere
-0.25
■
PRESCRIPTIONS_SPHERE_OS
OS: Prescription sphere
-0.25
■
PRIMARY_PHYSICIAN
Name of the primary care
physician for the patient
Dr. Walter Reed, MD
■
■
PRIMARY_PHYSICIAN_PHONE
Phone number for the
primary care physician [(000)
000-0000]
(305) 555-5555
■
■
PROVIDER_NAME
Default provider for the
patient
Dr. Herman Snellen
■
■ ■
Transaction time [00:00:00]
15:53:28
■
S_PDF_FILETO_STORE
TIME_STAMP
■
■ ■