| Field # | Field Name | Format | Min | Max | Req'd | Comment |
|---|---|---|---|---|---|---|
| 1 | RecordID | 6 | 6 | Y | ||
| 2 | PatientAccountNumer | AN | 1 | 80 | O | |
| 3 | ClientID | AN | 1 | 80 | O | |
| 4 | PatientLastName | AN | 1 | 35 | O | |
| 5 | PatientFirstName | AN | 1 | 25 | O | |
| 6 | PatientMiddleName | DT | 1 | 25 | O | |
| 7 | PatientDOB | DT | 1 | 35 | O | |
| 8 | PatientEmail | AN | 1 | 50 | O | |
| 9 | Provider ID | AN | 1 | 80 | O | |
| 10 | APC Enrolled | A | 1 | 1 | O | Y / N |
| 11 | eStatement Enrolled | A | 1 | 1 | O | Y / N |