Living Dependency
Living Arrangement
Patient Primary Facility
Patient Primary Care Provider Name & ID No.
Student Indicator
Handicap
Living Will Code
Organ Donor Code
Separate Bill
Duplicate Patient
Publicity Code
Protection Indicator
Protection Indicator Effective Date
Place of Worship
Advance Directive Code
Immunization Registry Status
Immunization Registry Status Effective Date
Publicity Code Effective Date
Military Branch
Military Rank/Grade
Military Status
Advance Directive Last Verified Date
