| Name | Description | Type | Additional information |
|---|---|---|---|
| Name | string |
Max length: 60 |
|
| Id | string |
Max length: 25 |
|
| Seq | string |
None. |
|
| PcpTc | string |
None. |
|
| LocationId | string |
None. |
|
| IsExistingPatient | boolean |
None. |
|
| IPA | string |
Max length: 25 |
|
| Address1 | string |
Max length: 50 |
|
| Address2 | string |
Max length: 50 |
|
| City | string |
Max length: 30 |
|
| State | string |
Max length: 2 |
|
| Zip | string |
Max length: 10 |
|
| Phone | string |
Max length: 15 |