---
FieldType: Text
FieldName: name
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: ssn
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: dob
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: homePhone
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: workPhone
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: cellPhone
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: email
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: icd10
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: cpt
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: caseTime
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: diagnosis
FieldFlags: 4096
FieldJustification: Left
---
FieldType: Text
FieldName: procedure
FieldFlags: 4096
FieldJustification: Left
---
FieldType: Text
FieldName: equipment
FieldFlags: 4096
FieldJustification: Left
---
FieldType: Button
FieldName: ASC
FieldFlags: 0
FieldValue: Yes
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Button
FieldName: ASC2
FieldFlags: 0
FieldValue: yes
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: yes
---
FieldType: Button
FieldName: ESP
FieldFlags: 0
FieldValue: yes
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: yes
---
FieldType: Button
FieldName: surgAdmit
FieldFlags: 0
FieldValue: yes
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: yes
---
FieldType: Button
FieldName: inpatient
FieldFlags: 0
FieldValue: yes
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: yes
---
FieldType: Button
FieldName: HP
FieldFlags: 0
FieldValue: yes
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: yes
---
FieldType: Button
FieldName: male
FieldFlags: 0
FieldValue: yes
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: yes
---
FieldType: Button
FieldName: female
FieldFlags: 0
FieldValue: yes
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: yes
---
FieldType: Button
FieldName: untitled8
FieldFlags: 0
FieldValue: yes
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: yes
---
FieldType: Button
FieldName: untitled9
FieldFlags: 0
FieldValue: yes
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: yes
---
FieldType: Button
FieldName: untitled10
FieldFlags: 0
FieldValue: yes
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: yes