Template Merge Fields
| Template Field Name | Description |
| DATE | |
| PATIENT_FIRST_NAME | |
| PATIENT_INITIAL | |
| PATIENT_LAST_NAME | |
| PATIENT_TITLE | |
| ADDRESS_LINE_1 | |
| ADDRESS_LINE_2 | |
| ADDRESS_LINE_3 | |
| ADDRESS_LINE_4 | |
| ADDRESS_LINE_5 | |
| ADDRESS_LINE_6 | |
| GROSS_FEE | |
| ADDITIONS | |
| DEDUCTIONS | |
| NET_FEE | |
| OP1_INF_DC_CQ | |
| OP1_INF_CC | |
| OP2_DEPOS_DCCQ | |
| OP2_PAYMS_DCCQ | |
| OP2_TOTAL_DCCQ | |
| OP2_DEPOS_CC | |
| OP2_PAYMS_CC | |
| OP2_TOTAL_CC |