Register a New Practice
Basic Practice Information
Practice Name 
Phone, Practice ID P S
E Mail
First Billing Provider / Practice Administrator
First Name        MI
Last Name Prv
User ID
Password
Agree to Terms       View Agreements
First Billing Provider
First Name      MI
Last Name
REGID
REGDATE
 
Regtime
REGSTATUS
Adddate
 
Addtime
Adduser
Upddate
 
Updtime
Upduser
NAMEONCARD
CARDTYPE
CARDNUMBER
EXPMONTH
EXPYEAR
CARDCSV
CARDPHONE
CARDSTREET
CARDCITY
CARDSTATE
CARDZIP
Entity
Pracid
                     
Basic Practice Information
Practice Name  {PRACTICENAME}
Phone, Practice ID {PHONE1} {PRACID_PREFERRED} {_UNBOUND_HYPERLINK_2} {_UNBOUND_HYPERLINK_3}
E Mail {E_MAIL}
First Billing Provider / Practice Administrator
First Name      {USER_FIRST_NAME}  MI {PROVMI}
Last Name {USER_LAST_NAME} Prv {PROV}
User ID {USERID}
Password {PASSWORD} {PASSWORD_CONFIRM}
Agree to Terms     {AGREE}  {_UNBOUND_HYPERLINK_4}
First Billing Provider
First Name      {PROVFIRSTNAME} MI {PROVMI}
Last Name {PROVLASTNAME}
REGID {REGID}
REGDATE {REGDATE}
Regtime {REGTIME}
REGSTATUS {REGSTATUS}
Adddate {ADDDATE}
Addtime {ADDTIME}
Adduser {ADDUSER}
Upddate {UPDDATE}
Updtime {UPDTIME}
Upduser {UPDUSER}
NAMEONCARD {NAMEONCARD}
CARDTYPE {CARDTYPE}
CARDNUMBER {CARDNUMBER}
EXPMONTH {EXPMONTH}
EXPYEAR {EXPYEAR}
CARDCSV {CARDCSV}
CARDPHONE {CARDPHONE}
CARDSTREET {CARDSTREET}
CARDCITY {CARDCITY}
CARDSTATE {CARDSTATE}
CARDZIP {CARDZIP}
Entity {ENTITY}
Pracid {PRACID}