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Patient Demographics Screen

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The Patient Demographics screen is the primary location of all patient contact information, as well as insurance and billing details. The Demographic screen has four primary tabs and a lower button bar:

Basic Demographics


Last Name - required (apostrophe's are allowed; minimum 1 character)

First Name - required

Middle Initial - optional (can enter multiple characters)

NOTE: You can enter the name in all lowercase for speed; it will be converted automatically.

Title - the patient's salutation

Suffix - generational suffixes such as Jr, Sr, III

Date of Birth (DOB) - highly recommended. Can enter just 2-digit year, but day/month require 2-digits.

Address block - you can customize the city/state/zip list under Settings in the Main Module.


clip0752NOTE:  If you have entered the Guarantor/Subscriber for this patient already, you can use the blue arrow to pull the Guarantor's data forward


Home Phone - primary telephone at home (Note that there is no cellphone field; use the Custom Fields)

Day Phone - typically the work phone number; can be used for cellphone also

Email - patient's email; will automatically check for correct formatting.

Employer - will display on the Insurance Claim form

Occupation -

Prior Exam - date of last encounter with patient




Gender - recommended. if not selected, you will be prompted on saving chart

Chart No. - created automatically and cannot be edited or changed.

Identification # - previously for Social Security number; can be used for any ID you wish.

Provider - the patients provider (in your office)




Insurance Company - select from list (you can add new companies in the Settings)

Insured Name - same as the Subscriber or Guarantor (e.g. who holds the policy)

Relationship - how is the Subscriber related to the patient (self or guarantor)

Insured ID - the insurance plan ID

Policy Group # - if the insurance plan has a group number, enter it here

Authorization # - if the insurance plan requires pre-approval and gives an authorization number

Notes - do not display on Claim Form; for your own internal use

Additional Insurance Plans - click the button to add or view additional plans (only for 2nd or additional)




HIPAA Notification status - allows you to indicate that patient has read/understood HIPAA requirements

Bad Address - if mail is returned and you wish to remove patient from mailing/recall lists

Inactive - if patient leaves the practice for some reason (charts will still be available for viewing)



More Information



Nickname - an alternate preferred name by the patient

Marital Status - will display on the Insurance Claim form

Hobbies - useful to track patient activities to assist provider rapport

Source - what got the patient into your office

Referred by - who, if anyone, got the patient into your office

Family Group - if a patient is part of a family, you can indicate it here

Emergency Contact - a person to contact if a medical emergency occurs in office.




Race/Ethnicity - hold the mouse over the letters to see what abbreviations indicate.

Patient Picture - if you wish to have an image of the patient you need to: (1) take picture with a digital camera or camcorder, (2) save the image to a shared network folder or similar, and (3) click the Set button to find and display the image. Click Clear to reset to blank image. NOTE: Patient photos display in the Main Module when you click the patient name once.




Custom Fields - up to six custom fields can be created for inclusion in the patient demographics. Once you create a field name, it CANNOT be altered. This is to prevent data mixing (e.g. you create a field called 'email' then want to change it to 'cell phone', but the original data remains). If you wish to change a field you can only create a new one (and stop using the old one). Custom Fields can contain nearly any data. Examples can include:  Cell Phone, Facebook ID, Nursing Home Facility, Prior Chart #, etc.




Chart Alerts - for important chart information that you wish to flag. The Alert icon will display at the top tab when you open the Patient Demographics, alerting you to the existence of a note. The Chart Alerts can be of any nature, but typically are special circumstances such as allergy notifications or collection accounts.



HIPAA Information


Notification of Privacy Policy - checking the HIPAA box on first Demographics screen auto checks these two boxes.




PHI Disclosures - Patient Health Information disclosures can be tracked on this screen.




Each time the patient or an outside entity sends a record request, you should use the "Add New" button to record the event. You can print the Disclosure list when/if a patient requests to know who has requested PHI. Be sure to click Save on the Patient Demographics screen to finalize the data.




Privacy Requests - any specific privacy requests can be noted here




Acquisition Date - the original date the patient was entered into the database (or otherwise acquired by the practice.

Recall Date - the date the patient is scheduled for recall visit.



Patient Notes


Free Text Notes - any sort of billing or personal notes can be entered in this section. It is NOT for clinical notes (it is not printed as part of the chart). The "Time/Date Stamp" will automatically add a separator after you enter the note with current date/time information.




Lower Button Bar



Customize Button - allows customization of lists/dropboxes (e.g. city, state, postal codes)

Print Button - prints either a Demographic Summary page or address label (on DYMO printer only)




Encounters Button - switches to Encounters view

Save Button - used after any changes are made to the demographic record. Also used to pull a chart when displayed in the Patient List into the Open Charts screen.

Balance Notice - if the patient has a balance due in ezClaimBiller, a red notification bar will display