99-2-0N Registration – Demographics New Patients – CommunityMed Family Urgent Care

CMed – Enter Patient Demographics

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HID Traffic Source

this variable shows where traffic came to this form from. Query string variable is checkinid

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DO WE NEED? HID Arrived

this variable is set to 4 when patient has arrived in the parking lot. the querystring variable is arvd. Default value is 0

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Visit ID

visit id passed to this form by booking

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HID Decimal Time

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Today Date

captures the date of entry for use in calculations

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Tomorrow Date

captures the date of entry for use in calculations

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HID Pull Visit

this pulls the visit record written by booking based on the Visit ID

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Patient ID

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Clinic ID

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Patient data pull

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Visit Reason EMR Id

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LKUP – New Patient State

= 1 is patient is new, 0 = patient is existing, no entry means patient is existing

Patient Details

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Patient Name(Required)

First Last

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Patient Date of Birth(Required)

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New or existing patient

New Patient

Existing Patient

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Patient (or parent for minors) Mobile Phone(Required)

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Patient (or parent for minors) Email(Required)

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Patient Age

PATIENT Address Info

Patient Address(Required)

Street Address Address Line 2 City State ZIP Code