Template Merge Fields
| Template Field Name | Description |
| PATIENT_ID | |
| PATIENT_FIRST_NAME | |
| PATIENT_INITIAL | |
| PATIENT_LAST_NAME | |
| PATIENT_TITLE | |
| PATIENT_ADDRESSED_AS | |
| PATIENT_SALUTATION | |
| PATIENT_KA | Known As |
| ADDRESS_LINE_1 | |
| ADDRESS_LINE_2 | |
| ADDRESS_LINE_3 | |
| ADDRESS_LINE_4 | |
| ADDRESS_LINE_5 | |
| ADDRESS_LINE_6 | |
| PROVIDER_TITLE | |
| PROVIDER_FIRST_NAME | |
| PROVIDER_INITIAL | |
| PROVIDER_LAST_NAME | |
| APPOINTMENT_DATE | |
| CONSENT_DATE | |
| TODAYS_DATE | |
| FORM_TITLE | |
| FORM_CONTENT | |
| FORM_DISCLAIMER | |
| FORM_OUTCOME | |
| PATIENT_SIGNATURE |