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Control Name

Type

Default Value / StateMandatory

Description

Find Patientpatient

text field + [...] selection button

empty / enabledNo

Patient information used to search for a patient.

The user can type it manually (e.g. a part of patient name, Member ID, Patient ID) and press Enter key or they can select it from the list which opens by pressing […] button. Patient details load to Patient Details tab.

Patient ID

text field

empty / disabledYesUnique identifier of a patient in Greenrain Facility database. Assigned automatically, always disabled.
Self-PaypaycheckboxFALSE / enabledNo

The indicator that shows whether this is an insurance claim or not. If checked, Self-Pay drop-down appears.

Self-Paypaydrop-downempty / hiddenNo

The type of a patient that pays directly for the services/medication provided. The field becomes visible and mandatory when Self-Pay pay checkbox is selected.

Possible values:

  • Self-Pay;
  • Pro Forma Payer;
  • Medical Tourism Self-Pay;
  • Medical Tourism Other.

Payer ID

text field + [...] selection button

empty / enabledYes

The insurance company that pays the claim.

Format: code: company name.

The user can type it manually (e.g. a code) and press Enter key or they can select it from the list which opens by pressing […] button. If a payer is not in the list of licensed payers, the user can enter '@' followed by the name of the payer in the field.

The field and button become disabled when Self-Pay pay checkbox is selected.

TPA ID

text field + [...] selection button

empty / enabledNo

The third-party administrator that processes the claim.

Format: code: company name.

The user can type it manually (e.g. a code) and press Enter key or they can select it from the list which opens by pressing […] button.

The field and button become disabled when Self-Pay pay checkbox is selected.

The filed becomes mandatory when Payer ID = @value.

Member ID

text field

empty / enabledYes

Patient insurance card number for the specified payer.

Becomes disabled when Self-Pay pay checkbox is selected.

Cover PlanInsurance plan

drop-down

empty / enabledNo

Cover plan for the specified payer.

When the user sets Payer, Cover Plan drop-down fills automatically with custom values for this payer. The user can select a plan from the list or type another one – the new plan will be added to the list.

Becomes disabled when Self-Pay pay checkbox is selected.

MRNtext fieldempty / enabledYesUnique identifier of a patient on the provider side.

First Namename

text field

empty / enabledNo

Patient first name, free text.

Last Namename

text field

empty / enabledNo

Patient last name, free text.

Gender

drop-down list

empty / enabledNo

Patient gender.

Possible values:

  • Male;
  • Female.

Birth Datedate

date picker

empty / enabledNo

Patient birth date.

Emirates ID

drop-down list

Unknown status, without a card. / enabledYes

Patient Emirates ID.

Possible values:

  • National without a card;
  • Expatriate resident without a card;
  • Not national, not expatriate resident without a card;
  • Unknown status, without a card;
  • a value in the format NNN-NNNN-NNNNNNN-N entered manually.

Nationality

text field + [...] selection button

empty / enabledNo

Patient nationality.

Format: nationality: country.

The user can type it manually (e.g. a code) and press Enter key or they can select it from the list which opens by pressing […] button.

Mobile

text field

empty / enabledNo

Patient mobile number.

Work Teltel.

text field

empty / enabledNo

Patient work phone number.

Home Teltel.

text field

empty / enabledNo

Patient home phone number.

Address

text field

empty / enabledNo

Patient address or addresses, free text.

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