| Name | Description | Type | Additional information |
|---|---|---|---|
| FirstName | string |
None. |
|
| LastName | string |
None. |
|
| string |
None. |
||
| Phone | string |
None. |
|
| DOB | string |
None. |
|
| PreferredTime | string |
None. |
|
| PreferredDay | string |
None. |
|
| City | string |
None. |
|
| State | string |
None. |
|
| Insurance | string |
None. |
|
| Gender | string |
None. |
|
| Symptoms | string |
None. |
|
| MarketingSource | string |
None. |
|
| Message | string |
None. |
|
| PreviousVeinDisease | string |
None. |
|
| PreviousVeinTreatment | string |
None. |
|
| FamilyHistVeinDisease | string |
None. |
|
| ExperiencedSymptoms | string |
None. |
|
| SitStandLongTime | string |
None. |
|
| ProviderFirstName | string |
None. |
|
| ProviderLastName | string |
None. |
|
| ProviderAddress | string |
None. |
|
| ProviderCity | string |
None. |
|
| ProviderState | string |
None. |
|
| ProviderEmail | string |
None. |
|
| ProviderPhone | string |
None. |
|
| ProviderFax | string |
None. |
|
| Custom1 | string |
None. |
|
| Custom2 | string |
None. |
|
| Custom3 | string |
None. |
|
| Custom4 | string |
None. |
|
| Custom5 | string |
None. |
|
| ReceivedDate | date |
None. |
|
| MiddleName | string |
None. |
|
| Address | string |
None. |
|
| Zip | string |
None. |
|
| Country | string |
None. |
|
| PatientType | string |
None. |
|
| SourceURL | string |
None. |
|
| SourceReferrerURL | string |
None. |
|
| SubmitDate | string |
None. |
|
| LeadUId | string |
None. |
|
| ExternalID_1 | string |
None. |
|
| ExternalID_2 | string |
None. |
|
| InitialLeadType | string |
None. |
|
| LeadTiming | string |
None. |
|
| AuditedLeadType | string |
None. |
|
| AuditQualifier | string |
None. |
|
| ApptDate | string |
None. |
|
| AuditNotes | string |
None. |
|
| SiteName | string |
None. |
|
| OfficeID | string |
None. |
|
| SiteUID | string |
None. |
|
| UploadedFiles | string |
None. |
|
| CombinedLeadType | string |
None. |
|
| LeadExportResult | string |
None. |
|
| LeadExportResultCode | string |
None. |
|
| MyDoctor | string |
None. |
|
| FriendsOrFamily | string |
None. |
|
| Internet | string |
None. |
|
| string |
None. |
||
| Other | string |
None. |
|
| ReciveTextUpdates | string |
None. |
|
| HistorySpider | string |
None. |
|
| HistoryVaricose | string |
None. |
|
| HistoryOther | string |
None. |
|
| HistoryNone | string |
None. |
|
| SymptomsSwelling | string |
None. |
|
| SymptomsHeavyFatiguedLegs | string |
None. |
|
| SymptomsSkinDiscoloration | string |
None. |
|
| SymptomsBurningOrItchyLegs | string |
None. |
|
| SymptomsLegCramping | string |
None. |
|
| SymptomsRestlessLegs | string |
None. |
|
| SymptomsSoresOrOpenWounds | string |
None. |
|
| SymptomsDifficultyMoving | string |
None. |
|
| SymptomsNone | string |
None. |
|
| Form | string |
None. |
|
| Location | string |
None. |
|
| MDLocations | string |
None. |
|
| VaricoseVeins | string |
None. |
|
| Swelling | string |
None. |
|
| SpiderVeins | string |
None. |
|
| Fatigue | string |
None. |
|
| LegPain | string |
None. |
|
| Burning | string |
None. |
|
| Subject | string |
None. |
|
| LocationList | string |
None. |
|
| Procedure | string |
None. |
|
| Comment | string |
None. |
|
| ScreenerProgress | string |
None. |
|
| HowHear | string |
None. |
|
| MiddleInitial | string |
None. |
|
| NewPatient | string |
None. |
|
| Phone2 | string |
None. |
|
| Medium | string |
None. |
|
| InsFirstName | string |
None. |
|
| InsLastName | string |
None. |
|
| InsPlanName | string |
None. |
|
| InsGroupNumber | string |
None. |
|
| InsMemberNumber | string |
None. |