HL7 Manual Entry You are here: Home / HL7 Manual Entry ERA Manual Entry Basic Info HL7Version BatchNum PatientId Patient Demographics MRN ReferralSource Prefix FirstName * MiddleName LastName * Suffix PatientFullName * DOB * Gender * Male Female SSN Marital Status Single Married DivorcedDivorced Address1 * Address2 City * State * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Country * ZipCode * FullAddress * HomePhone WorkPhone MobilePhone Email Note CollCat GuaranDiffThanPatient No Yes Guarantor GuaranPrefix GuaranFullName GuaranFirstName GuaranMiddleName GuaranLastName GuaranSuffix GuaranFullAddress GuaranAddress1 GuaranAddress2 GuaranCity GuaranState GuaranCountry GuaranZipCode GuaranRelationship Employment EmploymentStatus EmployerName EmployeeId Physicians RenderingProviderInfo RenderingProviderId RenderingProviderName PrimaryCarePhysId PrimaryCarePhysName ReferringProviderInfo ReferringProviderId ReferringProviderName LocationId LocationName ClientLocationId EncounterStatus Add/Update Insurance Information? No Yes Patient Insurance Case Information - Primary CaseName CasePayerScenario CaseDescription SendStatements DidInsuranceChange ExistingCaseName PrimaryKareoPlanName PrimaryInsuranceId * PrimaryInsuranceName * PrimaryPlanName PrimaryPolicyGroup * PrimaryPolicyNumber * PrimaryRelationship PrimaryInsuranceAddress PrimaryInsuranceEffectiveDate PrimaryInsuranceEndDate SecondaryKareoPlanName SecondaryInsuranceId SecondaryInsuranceName SecondaryPlanName SecondaryPolicyGroup SecondaryPolicyNumber SecondaryRelationship SecondaryInsuranceAddress SecondaryInsuranceEffectiveDate SecondaryInsuranceEndDate ThirdKareoPlanName ThirdInsuranceId ThirdInsuranceName ThirdPlanName ThirdPolicyGroup ThirdPolicyNumber ThirdRelationship ThirdInsuranceAddress ThirdInsuranceEffectiveDate ThirdInsuranceEndDate Patient Alert Message AlertMsg ShowAlertPatientDetail No Yes ShowAlertSchedAppt No Yes ShowAlertSchedAppt No Yes ShowAlertEnteringEnctr No Yes ShowAlertPostingPaymnt No Yes ShowAlertViewingClaim No Yes ShowAlertStatements No Yes Encounter Information Pv1Encounter EncounterPatientId EncounterPatientFullName * EncounterFirstName * EncounterMiddleName * EncounterLastName * Encounter DOB * EncounterLocationId EncounterLocationName EncounterPlaceOfServiceCode EncounterPostDate EncounterDos(Date of Service) * EncounterEarliestDate EncounterLatestDate EncounterHospAdmitDate EncounterHospDischargeDate EncounterSchedulingProvider EncounterSchedProviderId EncounterSchedProviderFirstName EncounterSchedProviderMiddleName EncounterSchedProviderLastName EncounterRenderingProvider EncounterRenderingProviderId * EncounterRenderingProviderFirstName * EncounterRenderingProviderMiddleName * EncounterRenderingProviderLastName * EncounterSupervisingProvider EncounterSupervisProviderId EncounterSupervisProviderFirstName EncounterSupervisProviderMiddleName EncounterSupervisProviderLastName EncounterReferringProvider EncounterReferringProviderId EncounterReferringProviderFirstName EncounterReferringProviderMiddleName EncounterReferringPoviderLastName EncounterRawReferringData EncounterMedNotes DoNotSendClaimsElect DoNotSendToSecondary TransFileName MissingProcCode EncounterLabTestCode NOTE: Multiple service lines can be included in one Encounter Transaction Encounter Start Date * Encounter End Date Encounter Procedure Code * Encounter Modifier Date Encounter Diagnosis Codes * EncounterUnitQTY * Encounter Unit Price Submit If you are human, leave this field blank.