Personal Information Header

Last Name

This is the patient's last name. Assign or change a last name by typing the desired name into the Last Name text box.

First Name

This is the patient's first name. Assign or change a first name by typing the desired name into the First Name text box.

Birth Date

This is the day on which the patient was born. Assign or change the birth date by typing the desired date into the Birth Date text box using the format MM/DD/CCYY. Or, click on the calendar icon to set the date.

Please note that the system will not allow the changing of Birth Date to a date that is after existing immunizations. If such a date is entered, an error message will appear and the user will be expected to resolve the conflict with the existing immunizations via the edit immunization screen or by changing the Birth Date.

Mother's Maiden Last

This is the patient's mother's maiden last name. Assign the mother's maiden last name by typing the desired name into the Mother's Maiden Last text box.  Once the Mother's Maiden Last Name is populated and saved the text box will no longer appear and (On File) will display for this text box instead notifying that this information is recorded already.

Mother's First Name

This is the patient's mother's first name. Assign or change the mother's first name by typing the desired name into the Mother's First Name text box.

Gender

This is the patien'ts gender. Select the patient's gender from the gender pick list.

Middle Name

This is the patient's middle name. Assign or change a middle name by typing the desired name or initial into the Middle Name text box.

Suffix

This is the patient's name suffix if applicable.  Select the patient's suffix from the Suffix pick list.

Medi-Cal ID

This is the patient's Medi-Cal identification number. Assign or change the Medi-Cal id by typing the Medi-Cal id into the Medi-Cal ID text box.

Birth Order

Only enter this field for multiple births, such as twins or triplets. It is a number indicating the order in which the patient was born.

Birth Country

This is the country that the patient was born in.

Birth State

This is the State that the patient was born in.

Birth County

This is the county that the patient was born in.

Patient Identifier

This displays the primary patient identifier that associates the patient to the provider organization.

Last Updated by

This displays the last date that this patient was entered or edited by a provider organization, as well as the name of the provider organization.

Last Name

The system only accepts alpha characters, hyphens, and apostrophes.

First Name

The system only accepts alpha characters, hyphens, and apostrophes.

Middle Name

The system only accepts alpha characters, hyphens, and apostrophes.

Mother's Maiden Last

The system only accepts alpha characters, hyphens, and apostrophes.

Mother's First Name

The system only accepts alpha characters, hyphens, and apostrophes.

Birth Date

The system only accepts valid dates.  The system allows only dates on or after 01/01/1880 and before today's date.  The system allows only Birth Dates that are prior to immunization dates entered in the system.

Birth Order

The system only accepts numeric characters.