Abstraction Date
[ABSTRACTDATE] |
Instruction: Enter the date (i.e., today’s date) the office/clinic record
is abstracted in MM/DD/YYYY format.
This field will automatically populate when you save your entry
into this patient if the date field has been left blank. |
None |
None |
Medicare ID Number
[PATIDHIC] |
Instruction: Enter the patient’s Medicare/HIC number if the patient is a Medicare
consumer (Medicare/HIC numbers include both alpha AND numeric characters).
This field will be pre-populated with the patient’s Medicare
HIC. |
None |
None |
First Name
[FIRSTNAME] |
Instruction: Enter the patient’s first name.
This field will be pre-populated with the patient’s first
name. |
None |
None |
Last Name
[LASTNAME] |
Instruction: Enter the patient’s last name.
This field will be pre-populated with the patient’s last
name. |
None |
None |
| Gender |
Instruction: Select the patient’s gender. |
|
None |
| [GENDER] |
Male (1): Select this option
if the patient is male.
Female (2): Select this option if the patient is
female.
Unknown (3): Select this option if the patient’s
gender is unknown.
This field will be pre-populated with the patient’s gender.
|
- Male – symbol for male, he, him, his, M
- Female – symbol for female, she, her, F
Abbreviations: WDWM equals well developed white male. WDBF equals
well developed black female. |
Birth Date
[DATEOFBIRTH] |
Instruction: Enter the patient’s date of birth in MM/DD/YYYY format.
This field will be pre-populated with the patient’s birth
date. |
None |
None |
Medical Record Number
[MRNUMBER] |
Instruction: Enter the patient’s medical record number. |
None |
None |
Other ID Number
[PATIDOTHER] |
Instruction: If patient has insurance in addition to Medicare, enter the other insurance
ID number. |
None |
None |
Provider Name, Number
[PROVIDERNUMBER] |
Instruction: Enter the name and numeric identification code of the primary care
provider (i.e., NPI - (National Provider Identifier).
This field will be pre-populated with the NPI of the practitioner
that has provided the majority of care as shown by submitted claims. This field
may be modified by the abstractor. |
None |
None |