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Patient Registration - Motorola Solutions Mobile App

This application reports information concerning the patient. This includes their insurance, responsible party and the ones that are insured under the plan that has been established. The responsible party has optional screens and is used if the party has a relationship with the patient. This app can be used on any Motorola Solutions device, including the ES400 and ET1.

For more registration forms, try our patient registration app.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Patient Registration - Motorola Solutions Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    ID

  • Ico textbox

    Chart ID

  • Ico textbox

    First Name

  • Ico textbox

    Last Name

  • Ico textbox

    Middle Initial

  • Ico textbox

    Preferred Name

  • Ico dropdown

    Patient Is

  • Ico statictext

    Please complete the following information about the Responsibility Party.

  • Ico textbox

    First Name

  • Ico textbox

    Last Name

  • Ico textbox

    Middle Initial

  • Ico textbox

    Address

  • Ico textbox

    Address 2

  • Ico multiline

    City, State, Zip

  • Ico textbox

    Birth Date

  • Ico textbox

    Social Security

  • Ico textbox

    Driver's License

  • Ico dropdown

    Holder

  • Ico statictext

    Please complete the following information about the Responsibility Party.

  • Ico textbox

    Pager

  • Ico textbox

    Home Phone

  • Ico integer

    Work Phone

  • Ico integer

    Extension

  • Ico integer

    Cellular

  • Ico statictext

    Please complete the following information about the patient.

  • Ico textbox

    Address

  • Ico textbox

    Address 2

  • Ico textbox

    City

  • ...and More!

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