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Name
Patient
History*
Visit
Number
<Question
1>*
<Question
2>*
<Question
3>*
<Question
4>*
Attending
MD Last
Name*
5864335-001-1
Description
The patient's medical history
Visit number given to this patient.
The name of this text box is
configured by the administrator.
See the accepted values of these
text boxes before configuration.
Attending physician last name
MAC
™
5 A4/MAC
Length
Accepted Values
Not
•
Hypertension
Applicable
•
CAD
•
Cardiac Surgery
•
Unknown
Maximum
•
A to Z
19
•
a to z
characters
•
0 to 9
•
All characters are supported.
Alphanumeric
17
•
A to Z
characters
•
a to z
•
0 to 9
•
All characters are supported.
Number
10
•
0 to 9
characters
Extra
optional
one special
character (+)
or (-) in the
beginning
Yes or No or Unknown
Not
•
Yes
Applicable
•
No
•
Unknown
Maximum
•
A to Z
40
•
a to z
characters
•
0 to 9
•
All characters are supported.
™
5 A5/MAC
™
5 Lite
Patient Data Fields
309
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