Online Payment

Enter the amount you wish to pay, your hospital number, and the patient name.

{
  "Name": "Online Payment Form",
  "Alias": "online_payment_form",
  "IsSubscription": false,
  "Fields": [
    {
      "Name": "Patient Name",
      "Alias": "PatientName",
      "CreatedDateTime": "2021-09-15T02:33:09.92621",
      "UpdateDateTime": "2022-05-19T09:00:33.066271",
      "Type": 7,
      "IsMandatory": true,
      "FieldGroupType": 2,
      "Order": 1,
      "Options": [],
      "Id": "6806",
      "FormId": "6689"
    },
    {
      "Name": "Account Number",
      "Alias": "AccountNumber",
      "CreatedDateTime": "2021-09-15T02:33:09.926211",
      "UpdateDateTime": "2022-05-19T09:00:33.066271",
      "Type": 7,
      "IsMandatory": true,
      "FieldGroupType": 2,
      "Order": 2,
      "Options": [],
      "Id": "6807",
      "FormId": "6689"
    },
    {
      "Name": "Amount Paid",
      "Alias": "AmountPaid",
      "CreatedDateTime": "2021-09-15T02:33:09.926224",
      "UpdateDateTime": "2022-05-19T09:00:33.066271",
      "Type": 7,
      "IsMandatory": false,
      "FieldGroupType": 2,
      "Order": 4,
      "Options": [],
      "Id": "6828",
      "FormId": "6689"
    },
    {
      "Name": "Email",
      "Alias": "Email",
      "CreatedDateTime": "2021-09-15T02:33:09.92621",
      "UpdateDateTime": "0001-01-01T00:00:00",
      "Type": 7,
      "IsMandatory": true,
      "FieldGroupType": 1,
      "Order": 0,
      "Options": [],
      "Id": "6805",
      "FormId": "6689"
    },
    {
      "Name": "Accept Payment",
      "Alias": "AcceptPayment",
      "CreatedDateTime": "2021-09-15T02:33:09.926222",
      "UpdateDateTime": "0001-01-01T00:00:00",
      "Type": 12,
      "IsMandatory": false,
      "FieldGroupType": 1,
      "Order": 3,
      "Options": [],
      "Id": "6825",
      "FormId": "6689"
    }
  ],
  "PaymentAmount": 0.0,
  "ModuleItemId": 0,
  "FormType": "Generic",
  "ModuleName": "",
  "UniqueId": "4b2c45b4-a797-4596-9231-bc0ebdfcdd78",
  "Parent": {
    "Value": {
      "Id": 2295,
      "ModuleLayoutName": "Page Detail",
      "Enabled": true,
      "ReleaseDate": "2019-10-23T00:00:00",
      "ExpiryDate": "2099-12-12T01:00:00",
      "Weighting": 0,
      "Item_Rating": 0,
      "CodeEditor": false,
      "ExternalId": 0,
      "DisableForSiteSearch": false,
      "Author_Name": null,
      "Author_Url": null,
      "Author": 0,
      "SEOTitle": "Pay Online | Pay My Bill | Hospitals Near Me",
      "CustomProperties": "{}",
      "LastUpdatedDate": "2020-07-23T14:14:18",
      "Module_Alias": "Page",
      "Module_Id": 1522,
      "ParentName": "Patients",
      "ParentUrl": "/patients",
      "Name": "Pay Online",
      "UrlSlug": "pay-online",
      "Url": "/patients/pay-online",
      "MetaDescription": "Fill out an online payment form by entering the amount you wish to pay, your hospital number, and the patient name.",
      "ShowPageForSearchEngine": true,
      "CanonicalLink": null,
      "MetaTitle": "Pay Online | Pay My Bill | Hospitals Near Me",
      "ParentId": 2293,
      "Url_List": [
        "/patients/pay-online"
      ],
      "ParentId_List": [
        2293
      ],
      "EnableAMP": false,
      "AMPContent": null,
      "SocialMetaTags": null,
      "OpenGraphPropertiesValue": "{\"title\":\"\",\"type\":\"\",\"url\":\"\",\"locale\":\"\",\"image\":\"\"}",
      "SeoPriority": 0.5,
      "Description": "\n\n
\n
\n

Online Payment

\n

Enter the amount you wish to pay, your hospital number, and the patient name.

\n
\n\n
\n {% component type: \"form\", alias: \"online_payment_form\" %}\n \n \n
\n
", "TemplateName": null, "ItemCategories": null, "ItemCategoryIdList": null, "ItemTags": null, "SiteSearchKeywords": null, "ID": 2295, "CreatedByMemberId": "0", "IsHome": false, "Pagination": null, "OpenGraphProperties": { "title": "", "type": "", "url": "", "locale": "", "image": "" }, "Parent": null, "TemplateVirtualPointer": { "Pointer": 8491950041332711434, "TypeId": 1977186194, "InstanceId": 10, "DbTypeId": 1977186194, "DbInstanceId": 10 }, "Params": {} }, "Type": 5 }, "ReCaptcha_Sitekey": null, "Params": { "type": "form", "alias": "online_payment_form" } }