Template Merge Fields
| Template Field Name | Description |
| ADDRESS_LINE_1 | |
| ADDRESS_LINE_2 | |
| ADDRESS_LINE_3 | |
| ADDRESS_LINE_4 | |
| ADDRESS_LINE_5 | |
| ADDRESS_LINE_6 | |
| ITEM_CHARGED_PRICE | |
| ITEM_CHARGED_TOTAL | |
| ITEM_DATE | |
| ITEM_DESCRIPTION | |
| ITEM_PROVIDER_FIRST_NAME | |
| ITEM_PROVIDER_INITIAL | |
| ITEM_PROVIDER_LAST_NAME | |
| ITEM_PROVIDER_TITLE | |
| ITEM_QTY | |
| ITEM_SITE | |
| PATIENT_FIRST_NAME | |
| PATIENT_INITIAL | |
| PATIENT_LAST_NAME | |
| PATIENT_TITLE | |
| PATIENT_ADDRESSED_AS | |
| PATIENT_SALUTATION | |
| PATIENT_KA | Known As |
| TODAYS_DATE |