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Mappable Fields for Forms
Mappable Fields for Forms
Kate G avatar
Written by Kate G
Updated over a week ago

Overview

When creating form templates there are different fields in NikoHealth you can map to a form. This page contains a list of all the different NikoHealth fields split into two groups: simple fields and fields with subfields.

Simple Fields

  • PatientLocationName

  • PatientLocationAddressLine1

  • PatientLocationAddressLine2

  • PatientLocationCity

  • PatientLocationState

  • PatientLocationZipCode

  • PatientLocationFullAddress

  • PatientLocationPhone

  • PatientLocationCode

  • PatientLocationNpi

  • PatientLocationFax

  • PatientId

  • PatientFirstName

  • PatientLastName

  • PatientMiddleName

  • PatientInitials

  • PatientGender

  • PatientDateOfBirthday

  • PatientMaritalStatus

  • PatientHomePhone

  • PatientCellPhone

  • PatientWorkPhone

  • PatientEmail

  • PatientAddressLine1

  • PatientAddressLine2

  • PatientAddressCity

  • PatientAddressState

  • PatientAddressZipCode

  • PatientFullAddress

  • PatientSSN

  • InitDate

  • CurrentEventDatePlus31Days

  • CurrentEventDatePlus61Days

  • CurrentEventDatePlus90Days

  • ReferredPhysicianFirstName

  • ReferredPhysicianLastName

  • ReferredPhysicianMiddleName

  • ReferredPhysicianNpi

  • ReferredPhysicianSignature

  • ReferredPhysicianOfficePhone

  • ReferredPhysicianOfficeName

  • ReferredPhysicianOfficeAddress1

  • ReferredPhysicianOfficeAddress2

  • ReferredPhysicianOfficeCity

  • ReferredPhysicianOfficeState

  • ReferredPhysicianOfficeZipCode

  • ReferredPhysicianOfficeFullAddress

  • ReferredPhysicianFax

  • ReferredPhysicianEmail

  • ReferredPhysicianSalesRep

  • SignDate

  • PatientHeight

  • PatientWeight

  • OrganizationName

  • OrganizationFullAddress

  • OrganizationPhone

  • OrganizationAddressLine1

  • OrganizationAddressLine2

  • OrganizationAddressCity

  • OrganizationAddressState

  • OrganizationAddressZipCode

  • PatientEmergencyFirstName

  • PatientEmergencyLastName

  • PatientEmergencyRelationship

  • PatientEmergencyPhone

  • PrimaryInsuranceName

  • PrimaryInsurancePlanName

  • PrimaryPolicyEffectiveDate

  • PrimaryPolicyGroupNumber

  • PrimaryPolicyNumber

  • PrimaryInsurancePlanAddressLine1

  • PrimaryInsurancePlanAddressLine2

  • PrimaryInsurancePlanAddressCity

  • PrimaryInsurancePlanAddressState

  • PrimaryInsurancePlanAddressZipCode

  • PrimaryInsurancePlanPhone

  • PrimaryInsurancePlanFax

  • SecondaryInsuranceName

  • SecondaryInsurancePlanName

  • SecondaryPolicyEffectiveDate

  • SecondaryPolicyGroupNumber

  • SecondaryPolicyNumber

  • SecondaryInsurancePlanAddressLine1

  • SecondaryInsurancePlanAddressLine2

  • SecondaryInsurancePlanAddressCity

  • SecondaryInsurancePlanAddressState

  • SecondaryInsurancePlanAddressZipCode

  • SecondaryInsurancePlanPhone

  • SecondaryInsurancePlanFax

  • TertiaryInsuranceName

  • TertiaryInsurancePlanName

  • TertiaryPolicyEffectiveDate

  • TertiaryPolicyGroupNumber

  • TertiaryPolicyNumber

  • TertiaryInsurancePlanAddressLine1

  • TertiaryInsurancePlanAddressLine2

  • TertiaryInsurancePlanAddressCity

  • TertiaryInsurancePlanAddressState

  • TertiaryInsurancePlanAddressZipCode

  • TertiaryInsurancePlanPhone

  • TertiaryInsurancePlanFax

  • OrderLocationName

  • OrderPriorityLevel

  • OrderScheduledDate

  • OrderAdditionalNotes

  • OrderRecipientName

  • OrderDeliveryAddressLine1

  • OrderDeliveryAddressLine2

  • OrderDeliveryCity

  • OrderDeliveryState

  • OrderDeliveryZipCode

  • PatientEmployedBy

  • PatientCustomFields

  • CurrentDate

  • CurrentUserLastName

  • CurrentUserFirstName

  • CurrentUserEmail

Fields with Subfields

  • OrderCustomFields

    • Name

    • PartNumber

    • Qty

    • Uom

    • Hcpcs - Comma separated list of HCPCS

    • HcpcsDescription - List of HCPCS descriptions

    • Notes

    • Diagnosis - List of diagnosis

    • HasDiagnosis - If item has diagnosis

    • DiagnosisFormatted - Comma separated list of diagnosis

    • DiagnosisDescription - List of diagnosis description

    • DiagnosisDescriptionFormatted

  • OrderCostSharingItems

    • Charge Charge - amount for item, decimal.

    • Allowable - Expected amount for item, decimal.

    • ChargeFormatted - Charge amount for item, formatted string.

    • AllowableFormatted

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