Layers:

Layer: Patient Information INS Form (4)

Name: Patient Information INS Form

Display Field: objectid

Type: Feature Layer

Geometry Type: esriGeometryPoint

Description:

Service Item Id: 1febc067716f453b90d68df06f18118f

Copyright Text:

Default Visibility: true

MaxRecordCount: 5000

MaxSelectionCount: 0

Supported Query Formats: JSON, geoJSON, PBF

Min Scale: 0.0

Max Scale: 0.0

Supports Advanced Queries: true

Supports Statistics: true

Can Scale Symbols: false

Use Standardized Queries: true

Supports ValidateSQL: true

Supports Calculate: true

Extent:
XMin: NaN
YMin: NaN
XMax: NaN
YMax: NaN
Spatial Reference: 102100  (3857)  LatestVCSWkid(0)



Drawing Info:
Renderer:
Simple Renderer:
Symbol:
Style: esriSMSCircle
Color: [34, 142, 39, 255]
Size: 4.0
Angle: 0.0
XOffset: 0
YOffset: 0
Outline:
[0, 0, 0, 255] Width: 0
Label: N/A
Description: N/A
Transparency: 0
Labeling Info:
Advanced Query Capabilities:
Supports Statistics: true
Supports OrderBy: true
Supports Distinct: true
Supports Pagination: true
Supports TrueCurve: false
Supports Returning Query Extent: true
Supports Query With Distance: true
Supports Sql Expression: true
Supports Query With ResultType: true
Supports Returning Geometry Centroid: false
Supports Binning LOD: true
Supports Query With LOD Spatial Reference: true
Supports Percentile Statistics: true
Supports Having Clause: true
Supports Count Distinct: true
Supports Time Relation: false
Supports Sql Format: false
Supports Query Analytic: true
Supports Query With Current User: true


HasZ: false

HasM: false

Has Attachments: true

HTML Popup Type: esriServerHTMLPopupTypeAsHTMLText

Type ID Field:

Fields:
• objectid ( nullable: false, defaultValue: null, editable: false, length: 4, type: esriFieldTypeOID, modelName: objectid, alias: OBJECTID )
• form_guid ( modelName: form_guid, nullable: true, editable: true, defaultValue: null, length: 38, alias: Form GUID, type: esriFieldTypeGUID )
• coverage_check ( modelName: coverage_check, nullable: true, editable: true, defaultValue: null, length: 255, alias: Insurance or Coverage Check, type: esriFieldTypeString )
• patient_name ( modelName: patient_name, nullable: true, editable: true, defaultValue: null, length: 255, alias: Patient Name:, type: esriFieldTypeString )
• patient_dob ( modelName: patient_dob, nullable: true, editable: true, defaultValue: null, precision: 1, length: 29, alias: Patient DOB:, type: esriFieldTypeDate )
• patient_gender ( modelName: patient_gender, nullable: true, editable: true, defaultValue: null, length: 255, alias: Patient Gender:, type: esriFieldTypeString , Coded Values: [male: Male] , [female: Female] , [other: Other] , ...1 more... )
• patient_home_phone ( modelName: patient_home_phone, nullable: true, editable: true, defaultValue: null, length: 255, alias: Home Phone Number:, type: esriFieldTypeString )
• patient_mobile_phone ( modelName: patient_mobile_phone, nullable: true, editable: true, defaultValue: null, length: 255, alias: Mobile Phone Number:, type: esriFieldTypeString )
• responsible_party ( modelName: responsible_party, nullable: true, editable: true, defaultValue: null, length: 255, alias: Responsible Party for Patient Under 18, type: esriFieldTypeString )
• party_relation_to_client ( modelName: party_relation_to_client, nullable: true, editable: true, defaultValue: null, length: 255, alias: Relationship to Client, type: esriFieldTypeString )
• patient_address ( modelName: patient_address, nullable: true, editable: true, defaultValue: null, length: 255, alias: Address of Patient:, type: esriFieldTypeString )
• patient_address_2 ( modelName: patient_address_2, nullable: true, editable: true, defaultValue: null, length: 255, alias: Patient Address 2:, type: esriFieldTypeString )
• patient_city ( modelName: patient_city, nullable: true, editable: true, defaultValue: null, length: 255, alias: City:, type: esriFieldTypeString )
• patient_state ( modelName: patient_state, nullable: true, editable: true, defaultValue: null, length: 2, alias: State:, type: esriFieldTypeString )
• patient_zip ( modelName: patient_zip, nullable: true, editable: true, defaultValue: null, length: 5, alias: Zip:, type: esriFieldTypeString )
• prim_insurance_company_name ( modelName: prim_insurance_company_name, nullable: true, editable: true, defaultValue: null, length: 255, alias: Primary Insurance Company:, type: esriFieldTypeString )
• prim_insurance_identification_n ( modelName: prim_insurance_identification_n, nullable: true, editable: true, defaultValue: null, length: 255, alias: Primary Identification Number:, type: esriFieldTypeString )
• prim_insurance_group_number ( modelName: prim_insurance_group_number, nullable: true, editable: true, defaultValue: null, length: 255, alias: Primary Group Number:, type: esriFieldTypeString )
• prim_insurance_subscriber_name ( modelName: prim_insurance_subscriber_name, nullable: true, editable: true, defaultValue: null, length: 255, alias: Primary Subscriber Name:, type: esriFieldTypeString )
• prim_insurance_subscriber_dob ( modelName: prim_insurance_subscriber_dob, nullable: true, editable: true, defaultValue: null, precision: 1, length: 29, alias: Primary Subscriber Date of Birth:, type: esriFieldTypeDate )
• prim_subscriber_relationship_to ( modelName: prim_subscriber_relationship_to, nullable: true, editable: true, defaultValue: null, length: 255, alias: Primary Subscriber Relationship to Patient:, type: esriFieldTypeString )
• scnd_insurance_company_name ( modelName: scnd_insurance_company_name, nullable: true, editable: true, defaultValue: null, length: 255, alias: Secondary Insurance Company Name:, type: esriFieldTypeString )
• scnd_insurance_identification_n ( modelName: scnd_insurance_identification_n, nullable: true, editable: true, defaultValue: null, length: 255, alias: Secondary Indentification Number:, type: esriFieldTypeString )
• scnd_insurance_group_number ( modelName: scnd_insurance_group_number, nullable: true, editable: true, defaultValue: null, alias: Secondary Group Number:, type: esriFieldTypeDouble )
• scnd_insurance_subscriber_name ( modelName: scnd_insurance_subscriber_name, nullable: true, editable: true, defaultValue: null, length: 255, alias: Secondary Subscriber Name:, type: esriFieldTypeString )
• scnd_subscriber_dob ( modelName: scnd_subscriber_dob, nullable: true, editable: true, defaultValue: null, precision: 1, length: 29, alias: Secondary Subscriber Date of Birth:, type: esriFieldTypeDate )
• scnd_subscriber_relationship_to ( modelName: scnd_subscriber_relationship_to, nullable: true, editable: true, defaultValue: null, length: 255, alias: Secondary Subscriber Relationship to Patient:, type: esriFieldTypeString )
• tert_insurance_company_name ( modelName: tert_insurance_company_name, nullable: true, editable: true, defaultValue: null, length: 255, alias: Tertiary Insurance Company Name:, type: esriFieldTypeString )
• tert_insurance_identification_n ( modelName: tert_insurance_identification_n, nullable: true, editable: true, defaultValue: null, length: 255, alias: Tertiary Indentification Number:, type: esriFieldTypeString )
• tert_insurance_group_number ( modelName: tert_insurance_group_number, nullable: true, editable: true, defaultValue: null, length: 255, alias: Tertiary Group Number:, type: esriFieldTypeString )
• tert_insurance_subscriber_name ( modelName: tert_insurance_subscriber_name, nullable: true, editable: true, defaultValue: null, length: 255, alias: Tertiary Subscriber Name:, type: esriFieldTypeString )
• tert_subscriber_dob ( modelName: tert_subscriber_dob, nullable: true, editable: true, defaultValue: null, precision: 1, length: 29, alias: Tertiary Subscriber Date of Birth:, type: esriFieldTypeDate )
• tert_subscriber_relationship_to ( modelName: tert_subscriber_relationship_to, nullable: true, editable: true, defaultValue: null, length: 255, alias: Tertiary Subscriber Relationship to Patient:, type: esriFieldTypeString )
• staff_use_drivers_license_statu ( modelName: staff_use_drivers_license_statu, nullable: true, editable: true, defaultValue: null, length: 255, alias: Driver's License:, type: esriFieldTypeString , Coded Values: [copied: Copied] , [not_provided: DL - Not Provided] )
• staff_use_insurance_card_status ( modelName: staff_use_insurance_card_status, nullable: true, editable: true, defaultValue: null, length: 255, alias: Insurance/Medicaid Cards:, type: esriFieldTypeString , Coded Values: [copied: Copied] , [not_provided: INS - Not Provided] )
• staff_use_staff_initials ( modelName: staff_use_staff_initials, nullable: true, editable: true, defaultValue: null, length: 255, alias: Office Staff Initials:, type: esriFieldTypeString )
• staff_use_submission_date ( modelName: staff_use_submission_date, nullable: true, editable: true, defaultValue: null, precision: 1, length: 29, alias: Today's Date:, type: esriFieldTypeDate )
• scnd_insurance_yes_or_no ( modelName: scnd_insurance_yes_or_no, nullable: true, editable: true, defaultValue: null, length: 3, alias: Add Secondary Insurance?, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• tert_insurance_yes_or_no ( modelName: tert_insurance_yes_or_no, nullable: true, editable: true, defaultValue: null, length: 3, alias: Add Tertiary Insurance?, type: esriFieldTypeString , Coded Values: [yes: Yes] , [no: No] )
• globalid ( nullable: false, editable: false, defaultValue: null, length: 38, type: esriFieldTypeGlobalID, modelName: globalid, alias: GlobalID )
• created_user ( modelName: created_user, nullable: true, editable: false, defaultValue: null, length: 255, alias: created_user, type: esriFieldTypeString )
• created_date ( modelName: created_date, nullable: true, editable: false, defaultValue: null, precision: 1, length: 29, alias: created_date, type: esriFieldTypeDate )
• last_edited_user ( modelName: last_edited_user, nullable: true, editable: false, defaultValue: null, length: 255, alias: last_edited_user, type: esriFieldTypeString )
• last_edited_date ( modelName: last_edited_date, nullable: true, editable: false, defaultValue: null, precision: 1, length: 29, alias: last_edited_date, type: esriFieldTypeDate )
Templates:
• Name: Patient Information INS Form
  Description:
  Prototype:
  staff_use_insurance_card_status: null
  patient_state: null
  patient_address: null
  prim_insurance_subscriber_dob: null
  prim_subscriber_relationship_to: null
  prim_insurance_identification_n: null
  scnd_insurance_identification_n: null
  scnd_insurance_yes_or_no: null
  tert_insurance_identification_n: null
  patient_mobile_phone: null
  patient_name: null
  responsible_party: null
  patient_gender: null
  party_relation_to_client: null
  patient_dob: null
  patient_home_phone: null
  tert_insurance_yes_or_no: null
  scnd_insurance_subscriber_name: null
  tert_insurance_company_name: null
  patient_address_2: null
  tert_insurance_group_number: null
  scnd_insurance_group_number: null
  staff_use_staff_initials: null
  prim_insurance_company_name: null
  prim_insurance_subscriber_name: null
  staff_use_submission_date: null
  coverage_check: null
  tert_subscriber_dob: null
  staff_use_drivers_license_statu: null
  prim_insurance_group_number: null
  tert_insurance_subscriber_name: null
  tert_subscriber_relationship_to: null
  form_guid: null
  patient_city: null
  scnd_subscriber_dob: null
  patient_zip: null
  scnd_subscriber_relationship_to: null
  scnd_insurance_company_name: null
  
  Drawing Tool: esriFeatureEditToolPoint