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No.

Control Name

Type

Default Value / StateMandatory

Description

1

Find

Patient

patient

text

field

field + [...] selection button

empty / enabledNo

Patient information used to search for a patient.

Default value: empty.User

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

Details tab.

2

Patient ID

text field

Patient unique identifier.Default value: empty.Patient ID is not editable, it is assigned with new patient saving.

3

Payer ID

text field

Insurance company which pays the claim.Default value: empty.

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

Payer ID

text field + [...] selection button

empty / enabledNo

The insurance company that pays the claim.

Format: code: company name.

User

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.

4

 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.

TPA ID

text

fieldThird

field + [...] selection button

empty / enabledNo

The third-party administrator that processes the claim.

Default value: empty.

Format: code: company name.

User

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.

5

Member ID

text field

empty / enabledNo

Patient insurance card number for the specified payer.

Default value: empty.

6

Cover Plan

Insurance plan

drop-down

empty / enabledNo

Cover plan for the specified payer.

Default value: empty.

When the user sets Payer ID,

Cover Plan

Insurance plan drop-down fills automatically with custom values for this payer.

User

The user can select a plan from the list or type another one – the new plan will be added to the list.

7
MRNtext fieldempty / enabledNoUnique identifier of a patient on the provider side.

First

Name

name

text field

empty / enabledNo

Patient first name

.Default value: empty

, free text.

8

Last

Name

name

text field

empty / enabledNo

Patient last name

.Default value: empty.9

, free text.

Gender

drop-down list

empty / enabledNo

Patient gender.

Default value: empty.

Possible values:

  • Male
,
  • ;
  • Female.
10

Birth

Date

date

date picker

empty / enabledNo

Patient birth date.

Default value: empty.11

Emirates ID

drop-down list

Patient Emirates ID.Default value:
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
12
  • ;
  • a value in the format NNN-NNNN-NNNNNNN-N entered manually.

Nationality

text

field

field + [...] selection button

empty / enabledNo

Patient nationality.

Default value: empty.

Format: nationality: country.

User

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.

13

Mobile

text field

empty / enabledNo

Patient mobile number

.Default value: empty

.

14

Work

Tel

tel.

text field

empty / enabledNo

Patient work phone number

.Default value: empty

.

15

Home

Tel

tel.

text field

empty / enabledNo

Patient home phone number

.Default value: empty

.

16

Address

text field

empty / enabledNo

Patient address or addresses

.Default value: empty

, free text.