Loginmsgid 2
  {_UNBOUND_STATICTEXT_1}
Loginmsgid {LOGINMSGID}

REGISTER YOUR PRACTICE
Basic Practice Information
Prac Name
Prac Email
Prac Type
 
Tax ID SocSec
Prac Phone
First Billing Provider / Practice Administrator
First Name   MI
Last Name Prv
User ID
Password
Confirm
Agree to terms
 
  View Agreements
First Billing Provider
First Name      MI
Last Name
REGID
REGDATE
 
Regtime
REGSTATUS
Adddate
 
Addtime
Adduser
Upddate
 
Updtime
Upduser
NAMEONCARD
CARDTYPE
CARDNUMBER
EXPMONTH
EXPYEAR
CARDCSV
CARDPHONE
CARDSTREET
CARDCITY
CARDSTATE
CARDZIP
Pracid
                 
Basic Practice Information
Prac Name {PRACTICENAME}
Prac Email {E_MAIL}
Prac Type {ENTITY} {_UNBOUND_STATICTEXT_1}{_UNBOUND_STATICTEXT_2} {TAXID} {PRACID_PREFERRED}
Prac Phone {PHONE1}
First Billing Provider / Practice Administrator
First Name {USER_FIRST_NAME}  MI {PROVMI}
Last Name {USER_LAST_NAME} Prv {PROV}
User ID {USERID}
Password {PASSWORD}
Confirm {PASSWORD_CONFIRM}
Agree to terms {AGREE}  {_UNBOUND_HYPERLINK_4}
First Billing Provider
First Name      {PROVFIRSTNAME} MI {PROVMI}
Last Name {PROVLASTNAME}
REGID {REGID}
REGDATE {REGDATE}
Regtime {REGTIME}
REGSTATUS {REGSTATUS}
Adddate {ADDDATE}
Addtime {ADDTIME}
Adduser {ADDUSER}
Upddate {UPDDATE}
Updtime {UPDTIME}
Upduser {UPDUSER}
NAMEONCARD {NAMEONCARD}
CARDTYPE {CARDTYPE}
CARDNUMBER {CARDNUMBER}
EXPMONTH {EXPMONTH}
EXPYEAR {EXPYEAR}
CARDCSV {CARDCSV}
CARDPHONE {CARDPHONE}
CARDSTREET {CARDSTREET}
CARDCITY {CARDCITY}
CARDSTATE {CARDSTATE}
CARDZIP {CARDZIP}
Pracid {PRACID}