Referring ProviderExtract the referring physician/provider name...
Referring Provider NPIExtract the referring provider NPI...
Referring PracticeExtract the referring practice/facility name...
Referring PhoneExtract the referring provider phone number...
Referring FaxExtract the referring provider fax number...
Referred To ProviderExtract the specialist/provider being referred to...
Referred To SpecialtyExtract the specialty being referred to...
Patient NameExtract the patient name...
Patient DOBExtract the patient date of birth. Return in YYYY-...
Patient IDExtract patient ID or MRN...
InsuranceExtract the patient insurance/payer name...
Member IDExtract the insurance member ID...
Referral DateExtract the referral date. Return in YYYY-MM-DD fo...
Referral NumberExtract the referral authorization number if prese...
Valid FromExtract the referral valid from date. Return in YY...
Valid ToExtract the referral expiration date. Return in YY...
Visits AuthorizedExtract the number of visits authorized...
DiagnosisExtract the diagnosis or reason for referral...
ICD CodesList any ICD-10 diagnosis codes...
Clinical NotesExtract relevant clinical notes or history...
UrgencyIdentify urgency: Routine, Urgent, Emergent...
Prior Auth RequiredIs prior authorization required? Yes, No, or Unkno...
AttachmentsList any attachments mentioned (labs, imaging, etc...