| Description | Short Desc | Field Type | Attribution Type | Length | Primary | Sticky | Mandatory | Prefilled |
| Facility | Facility | Attribution Type | Facility | 50 | Yes | No | Yes | Yes |
| Account No. | Account # | Text | 20 | Yes | No | Yes | No | |
| Medical Record No. | Med Rec # | Text | 20 | No | No | No | No | |
| Patient Name | Pt Name | Text | 50 | No | No | No | No | |
| Admit Date | Admit Date | Date | 10 | No | No | No | No | |
| Discharge Date | Dschg Date | Date | 10 | No | No | No | No | |
| Review Date | Rev Date | Date | 10 | No | No | No | No | |
| Physician | Physician | Attribution Type | Physician | 50 | No | No | No | Yes |
| Department | Department | Attribution Type | Department | 50 | No | No | No | Yes |
| Description | Short Desc | Field Type | Attribution Type | Length |
| Physician | Physician | Attribution Type | Physician | 50 |
| Department | Department | Attribution Type | Department | 50 |
|