Overview
The Create Organization page is used to record the name and address of a guarantor organization.
Field Definitions
Field | Type | Required | Description |
|---|---|---|---|
| Name and Address Section | |||
| Name | Free Text | Yes | The name of the organization responsible for the patient. |
| Address | Free Text | Yes | The street address of the organization responsible for the patient. |
| City | Free Text | Yes | The city the organization is located in. The field will auto-populate when the Zip Code is entered. However, the field can be edited by typing the name of the city in the space provided. |
| State | Free Text | Yes | The state abbreviation where the organization is located. The field will auto-populate when the Zip Code is entered. However, the field can be edited by typing the state abbreviation or selecting an option from the drop down list. |
| Zip Code | Free Text (Numeric) | Yes | The five-digit plus 4-digit postal code where the organization is located. |
| Tax ID Section | |||
| Tax ID Number | Drop Down / Free Text | No | The number an organization uses as its tax identification number: Employer Identification Number (EIN) or Social Security Number (SSN). |
| Contact Information Section | |||
| Contact Name | Free Text | No | The Last, First, and Middle names of the person at the organization who is the primary contact. A Suffix, for example, Sr., Jr., or III, can also be entered, if applicable. |
| Phone Number | Free Text (Numeric) | No | The primary telephone number and extension (if applicable) of the contact at the organization. |
| Fax Number | Free Text (Numeric) | No | The primary facsimile number and extension (if applicable) of the contact at the organization. |