Template Merge Fields
| Template Field Name | Description |
| PATIENT_TITLE | |
| PATIENT_INITIAL | |
| PATIENT_FIRST_NAME | |
| PATIENT_LAST_NAME | |
| PATIENT_DOB | |
| 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 | |
| CREATED_ON | |
| MC_FORMTEXT | Medical History Form Text |
| MC_FORMEXTRA | |
| MC_COMMENT | |
| MC_YES | |
| MC_NO | |
| TODAYS_DATE | |
| PATIENT_SIGNATURE |