Review this help section for detailed instructions regarding creating an editable PDF in the MediTouch System. Review “Editable PDFs in Custom Forms” for more information regarding using Editable PDFs in the EHR.
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- Adobe Acrobat Pro or a similar software should be used.
- Add attributes as desired (text fields, check boxes, etc.).
- Using HealthFusion field names will pre-populate the form.
![editable-pdf-4]()
- To rename a field, right click on the field and select “Rename Field.”
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- Only standard fonts should be used (e.g. Ariel, Times New Roman, etc.).
- Using unsupported font will cause a 404 error when using the form.
The field name options are listed below:
Patient (23 fields)
Patient First Name <=======================> MEMBER_FIRST_NAME
Patient Middle Name <======================> MEMBER_MIDDLE_NAME
Patient DOB <==============================> MEMBER_DOB
Patient SSN <==============================> MEMBER_SSN
Patient Chart No. <========================> MEMBER_PATIENT_ACCOUNT_NO
Patient Home Phone <=======================> MEMBER_HOME_PHONE
Patient Address Line1 <====================> MEMBER_ADDRESS1
Patient Address Line2 <====================> MEMBER_ADDRESS2
Patient City <=============================> MEMBER_CITY
Patient State <============================> MEMBER_STATE
Patient Zip <==============================> MEMBER_ZIP
Patient Work Phone <=======================> MEMBER_WORK_PHONE
Patient Cell Phone <=======================> MEMBER_CELL_PHONE
Patient Email <============================> MEMBER_EMAIL
Patient Emergency First Name <=============> MEMBER_EMERGENCY_FIRST_NAME
Patient Emergency Last Name <==============> MEMBER_EMERGENCY_LAST_NAME
Patient Emergency Phone <==================> MEMBER_EMERGENCY_PHONE
Patient Emergency Address1 <===============> MEMBER_EMERGENCY_ADDRESS1
Patient Emergency Address2 <===============> MEMBER_EMERGENCY_ADDRESS2
Patient Emergency City <===================> MEMBER_EMERGENCY_CITY
Patient Emergency State <==================> MEMBER_EMERGENCY_STATE
Patient Emergency Zip <====================> MEMBER_EMERGENCY_ZIP
Patient Last Name <========================> MEMBER_LAST_NAME
Practice (11 fields)
Practice Name <============================> PRACTICENAME
Practice Email <===========================> EMAILWORK
Practice Contact First Name <==============> CONTACTFIRSTNAME
Practice Contact Last Name <===============> CONTACTLASTNAME
Practice NPI <=============================> NPI
Practice Address Line1 <===================> PRACTICE_ADDRESS1
Practice Address Line2 <===================> PRACTICE_ADDRESS2
Practice City <============================> PRACTICE_CITY
Practice State <===========================> PRACTICE_STATE
Practice ZIP <=============================> PRACTICE_ZIPCODE
Practice Work Phone <======================> PRACTICE_PHONEWORK
Provider (20/32 fields)
Provider Suffix <==========================> PROV_SUFFIX
Provider Last Name <=======================> PROV_LASTNAME
Provider First Name <======================> PROV_FIRSTNAME
Provider Middle Name <=====================> PROV_MIDDLE_NAME
Provider Location Name <===================> PROV_LOCATIONNAME
Provider Tax Id <==========================> PROV_TAX_ID
Provider Lic. State <======================> PROV_LICENSEISSUINGSTATE
Provider Specialty <=======================> PROV_SPECIALITY
Provider Email <===========================> PROV_EMAIL
Provider Lic. No. <========================> PROV_LICENSENO
Provider Title <===========================> PROV_TITLE
Provider NPI <=============================> PROV_NPI
Provider Taxonomy Code <===================> PROV_TAXONOMY_CODE
Provider DEA Number <======================> PROV_DEA_NUMBER
Provider Address Line1 <===================> PROV_ADDRESS1
Provider Address Line2 <===================> PROV_ADDRESS2
Provider City <============================> PROV_CITY
Provider State <===========================> PROV_STATE
Provider Zip <=============================> PROV_ZIPCODE
Provider Work Phone <======================> PROV_PHONEWORK
