Custom Fields for Location: MacCloskey Kesler & Associates
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Name
Field Key
Data Type
Model
Field ID
Active
Treatment 1
opportunity.treatment_1
TEXT
opportunity
1hgGACbJnVvss6edhM7f
SSN 5
opportunity.ssn_5
TEXT
opportunity
1A0pDSm5UHgMahFLLCQC
Treatment 3
opportunity.treatment_3
TEXT
opportunity
4HX63v7Hvqkv9Ws4FDDE
Relationship 4
opportunity.relationship_4
SINGLE_OPTIONS
opportunity
5LmhRTSgUhrUEL3SOSDz
Relationship 3
opportunity.relationship_3
MULTIPLE_OPTIONS
opportunity
DskluKJb1xAXjQdyDsW1
Family Member 1 Name
opportunity.family_member_1_name
TEXT
opportunity
Fapm8wlAMMgFqw12wIEo
SSN 2
opportunity.ssn_2
TEXT
opportunity
Gzzu8waIn33yqO9SES6u
DOB 2
opportunity.dob_2
DATE
opportunity
KcZh3wTxHzUtK1FQwLfP
Injury 5
opportunity.injury_5
TEXT
opportunity
P04x61GWlMxAu6ePxLE6
Treatment 5
opportunity.treatment_5
TEXT
opportunity
PinIgmAWyBPwNCK2tjt3
Family Member 2 Name
opportunity.family_member_2_name
TEXT
opportunity
V4ZWAd9v719JoQp5CEHj
DOB 5
opportunity.dob_5
DATE
opportunity
VqxvL2IqKWvBM0kL5ALm
SSN 3
opportunity.ssn_3
TEXT
opportunity
YVY5VCMZjzn5BHyDRxpT
Relationship 2
opportunity.relationship_2
SINGLE_OPTIONS
opportunity
YEj0srDtwjGXrpCvIaJv
Family Member 3 Name
opportunity.family_member_3_name
TEXT
opportunity
ZyI4qYYUrmhWuw4tdicD
DOB 1
opportunity.dob_1
DATE
opportunity
b1FfacRDyEB8bhNhqifA
Family Member 5 Name
opportunity.family_member_5_name
TEXT
opportunity
e60hPQhNUzVd3ChTFM9v
Best Form of Contact
opportunity.best_form_of_contact
SINGLE_OPTIONS
opportunity
drHolF3ZLs6qCeK36Pmo
Injury 3
opportunity.injury_3
TEXT
opportunity
fMjWlFF5nuhAtjZZjhlR
Family Member 4 Name
opportunity.family_member_4_name
TEXT
opportunity
fbOA7RcNyTGXJda1lw5o
SS#
opportunity.ss
TEXT
opportunity
iFaTe5wuhWXe5z2wM8DP
DOB 4
opportunity.dob_4
DATE
opportunity
jamjoM5wz537dyjHR3N7
SSN 1
opportunity.ssn_1
TEXT
opportunity
mbx9Ox8FQC8j0bOIED6j
Family Notes
opportunity.family_notes
LARGE_TEXT
opportunity
oJ9DZzdHAlH8ICsWBzyj
SSN 4
opportunity.ssn_4
TEXT
opportunity
qHdTLSDDbjwDFIN5CMda
Treatment 4
opportunity.treatment_4
TEXT
opportunity
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Relationship 5
opportunity.relationship_5
SINGLE_OPTIONS
opportunity
s0xJdzNIVQkvHVUFDJ5O
DOB
opportunity.dob
DATE
opportunity
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Injury 2
opportunity.injury_2
TEXT
opportunity
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Relationship 1
opportunity.relationship
SINGLE_OPTIONS
opportunity
u4FSpAtDXwcd6ztLam3u
Injury 4
opportunity.injury_4
TEXT
opportunity
uvKzyw0Im0sva1VWaGww
Marital Status
opportunity.marital_status
SINGLE_OPTIONS
opportunity
e5t6reBzlyUSaTJC2uNV
Home Phone
opportunity.home_phone
PHONE
opportunity
CiZODutUPipkuW2Jyvwt
Cell Phone
opportunity.cell_phone
PHONE
opportunity
Y2O6ugTpIumQxx3UXRzD
SSN
opportunity.ssn
TEXT
opportunity
Zn7U6XzWDDZ8jNVmRQd9
Callrail Called Number
contact.callrail_called_number
TEXT
contact
FoYDSKEWLzz3oCUo5XIy
Call Rail GCLID
contact.call_rail_gclid
TEXT
contact
koD0au9wK0UpbOKULk8V
Call Rail Keywords
contact.call_rail_keywords
TEXT
contact
WKxMdR7hBFnIezEJi56S
Call Rail Call Type
contact.call_rail_call_type
TEXT
contact
mWo25Mq0wQwoIqDtOFU3
Call Rail Source
contact.call_rail_source
TEXT
contact
AmWNz3KV9JjUwBalK3ec
Call Rail medium
contact.call_rail_medium
TEXT
contact
GOAm7x3XQC7c3q2b43xN
fbclid
contact.fbclid
TEXT
contact
0ycF69C6MlHVx6PdMIcH
Referral Partner
opportunity.referral_partner
SINGLE_OPTIONS
opportunity
3C7me9jjqF93ZM90qfmb
Referral Firm Name
opportunity.referral_firm_name
TEXT
opportunity
fAteyomq39QoacHsc5ZP
Emergency Contact Email Address
opportunity.emergency_contact_email_address
TEXT
opportunity
siAxApYlPcIwkwpYVw7D
Emergency Contact Person’s Name
opportunity.emergency_contact_persons_name
TEXT
opportunity
jIZIl8n9tUW6mwSh4M33
Emergency Contact’s Phone
opportunity.emergency_contacts_phone
TEXT
opportunity
i1R1kFUiLPMXQBq0aChc
Injury
contact.injury
TEXT
contact
VMVwtQDH3hpZXtzl2K3H
Treatment
contact.treatment
TEXT
contact
IixCWoRZw4cpaep2ysY9
Case Evaluation
contact.case_evaluation
TEXT
contact
NJHZn9lDs7e1BrXGrpS1
Liability & Coverage
contact.liability__coverage
TEXT
contact
m1XnB3a3wPPooyJE2ihV
Timeframe
contact.timeframe
TEXT
contact
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Treatment 2
opportunity.treatment_2
TEXT
opportunity
TiiIdGo3VlflfWS4HyP3
Injury 1
opportunity.injury_1
TEXT
opportunity
S9BobR7S3d6A6dDpLtQY
UTM source
contact.utm_source
TEXT
contact
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UTM medium
contact.utm_medium
TEXT
contact
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UTM campaign
contact.utm_campaign
TEXT
contact
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Referral Notes
opportunity.referral_notes
LARGE_TEXT
opportunity
9p2hkTJwrMCNtMXGOLS1
response_pdf
contact.response_pdf
FILE_UPLOAD
contact
wNSbqCCd9lfpSupdGtai
DOB 3
opportunity.dob_3
DATE
opportunity
Clg5373AQMHSIn4W8PUg
Referral Firm Attorney First Name
opportunity.referral_firm_attorney_first_name
TEXT
opportunity
u8HQvda3VWmYNnQdd6Uy
Referral Firm Attorney Last Name
opportunity.referral_firm_attorney_last_name
TEXT
opportunity
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Referral Firm Phone Number
opportunity.referral_firm_phone_number
TEXT
opportunity
FJcBQsPEiQqUcwZbwhPY
Referral Firm Website
opportunity.referral_firm_website
TEXT
opportunity
qyZRn7Nc0X42P2MuI1Gy
Referral Firm Email
opportunity.referral_firm_email
TEXT
opportunity
fy8VnKmTyA4k6ahkROqq
Referral Status
opportunity.referral_status
TEXT
opportunity
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Referral Case Type
opportunity.referral_case_type
SINGLE_OPTIONS
opportunity
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Referral Practice Area
opportunity.referral_practice_area
TEXT
opportunity
wzra2f9g9Z9zB2ZyP2LO
Street Address
opportunity.street_address
TEXT
opportunity
muGlPd8N0dGiNtUYsRBv
City
opportunity.city_
TEXT
opportunity
cQw1nNbpTYD1bHstSxj4
State
opportunity.state_
TEXT
opportunity
2X22VOkdVIkzf7ZyfuBW
Zip
opportunity.zip
TEXT
opportunity
yYzwIsBUSoRnjd6qakwX
Reason for rejection
opportunity.reason_for_rejection
SINGLE_OPTIONS
opportunity
YqwJnX6msAiaOtdVhD8R
Reason for Rejection - Other notes
opportunity.reason_for_rejection__other_notes
LARGE_TEXT
opportunity
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Internal review
opportunity.internal_review
SINGLE_OPTIONS
opportunity
2Gifa2I5di9GoPn5ZIIk
Lost Reason (Notes)
opportunity.lost_reason_notes
LARGE_TEXT
opportunity
joEyl8p4ONY9g8sgQ2Wd
Salutation:
opportunity.salutation
SINGLE_OPTIONS
opportunity
TyJWKm3AY3m0KprZy7vd
Pronouns:
opportunity.pronouns
SINGLE_OPTIONS
opportunity
JvhRqoG0hpUOQN3UFtbf
Case Number
opportunity.case_number
TEXT
opportunity
13UhuafResYyWaNbI5Er
Propery Damage
opportunity.propery_damage
TEXT
opportunity
2cYh3DYvpofHlk1E4Ydv
County
opportunity.county
TEXT
opportunity
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Witness 2 Name
opportunity.witness_name_2
TEXT
opportunity
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Agency
opportunity.agency
TEXT
opportunity
BjOWDi8H6rCFHV9jgKPv
Witness 3 Phone
opportunity.witness_3_phone
TEXT
opportunity
DIZnJdMiEn02Gb0WJwWX
City
opportunity.city
TEXT
opportunity
FMgjr85YDTZzZDFvYdJ6
Witness 2 Phone
opportunity.witness_phone_2
TEXT
opportunity
H9bErdHvp6oWT2BSogWg
Vehicle Repaired
opportunity.vehicle_repaired
TEXT
opportunity
IO3SvrbYqFxVpZkKRuOt
Witness 3 Name
opportunity.witness_name_3
TEXT
opportunity
OhgchWATDa8gfqW18rcs
Photos Of Damage
opportunity.photos_of_damage
RADIO
opportunity
VU2lvdF08TcTQoxYXIMf
State
opportunity.state
TEXT
opportunity
UphZGluK6nrF1rH0VxE2
Location
opportunity.location
LARGE_TEXT
opportunity
Xwyu0Jodw3II4D4WEYMu
Details of the incident
opportunity.details_of_the_incident
LARGE_TEXT
opportunity
YHtTvqlUKO5fy2BNbOER
Witness 1 Phone
opportunity.witness_phone_1
TEXT
opportunity
cuwSMnRE3O0jKLnQyo25
Vehicle Location
opportunity.vehicle_location
TEXT
opportunity
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Citation
opportunity.citation
RADIO
opportunity
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Amount
opportunity.amount
TEXT
opportunity
ixLZRGgehHajwJxpaZkF
Witness 1 Name
opportunity.witness_name_1
TEXT
opportunity
mS7CQWbtXSOy5KRnGGTr
Hit & Run
opportunity.hit__run
RADIO
opportunity
qmI6Q0ug7jCFnzQatHDj
Date of Incident
opportunity.date_of_incident
DATE
opportunity
rY9T37MO3y98zwBPHB5P
Report No
opportunity.report_no
TEXT
opportunity
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Incident Notes
opportunity.incident_notes
LARGE_TEXT
opportunity
yAk05MgOt8iTGgOQLSzz
Fatality ?
opportunity.fatality_
RADIO
opportunity
R7trvqdb9WLDr2o1sDma
Dram?
opportunity.dram
RADIO
opportunity
6mFAyEn03kHTEVcznX89
Police Investigated
opportunity.police_investigated
SINGLE_OPTIONS
opportunity
RYdRYfBKWjw5zVWq2nSw
Attorney First Name
contact.attorney_first_name
TEXT
contact
3J1XXG1kaAoUZErc8XTV
Attorney Last Name
contact.attorney_last_name
TEXT
contact
0EqSFc1HK2hUKFwkRj0G
Supplemental
opportunity.supplemental
TEXT
opportunity
0ne3uAtPsZ7sqoR2JJru
Umbrella
opportunity.umbrella
RADIO
opportunity
2Ec6iHu1p1w0yRxZxkiL
Group Health Insurance
opportunity.group_health_insurance
TEXT
opportunity
AO4Ui6s36jBOdVqami0X
Plaintiff’s Auto Insurance
opportunity.plaintiffs_auto_insurance
TEXT
opportunity
F0FF1fwNLz1vXgN3vJed
Insurance #1
opportunity.insurance_1
TEXT
opportunity
J1sGL1Q1eScXQLBLd8Km
Insurance #2
opportunity.insurance_2
TEXT
opportunity
MYkz8q5z2yeP2P4aasWG
Defendant #1
opportunity.defendant_1
TEXT
opportunity
cMu1aV7ONgRU19YJhDV6
Defendant #2
opportunity.defendant_2
TEXT
opportunity
d1ifNfLq4SaomMVMg6ad
Policy No
opportunity.policy_no
TEXT
opportunity
uHbvoqIel2PKHT2hs1Ss
Insurance Amount
opportunity.insurance_amount
TEXT
opportunity
xk5CsPCCtgedxefvS3Q6
Liability ONLY
opportunity.liability_only
SINGLE_OPTIONS
opportunity
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Med Pay
opportunity.med_pay
SINGLE_OPTIONS
opportunity
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Contacted by Defendant’s Insurance
opportunity.contacted_by_defendants_insurance
SINGLE_OPTIONS
opportunity
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Offer Made
opportunity.offer_made
SINGLE_OPTIONS
opportunity
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Medicaid
opportunity.medicaid
SINGLE_OPTIONS
opportunity
OTRPsRhYlFY4mA8BgtXQ
Medicare
opportunity.medicare
SINGLE_OPTIONS
opportunity
nmmLwtSrJ3MWTNWzq6mc
Lost Wage Claim
opportunity.lost_wage_claim
TEXT
opportunity
2Fy235seFzS8jHekITRM
Other Attorney’s Lien
opportunity.other_attorneys_lien
TEXT
opportunity
2PiwmWMUldHOrASy3xMl
Given Lawyer Referral number
opportunity.given_lawyer_referral_number
TEXT
opportunity
A3cVykNmcYFDPw11CW5Y
Employer
opportunity.employer
TEXT
opportunity
FO6rcYGiXf6ocY1UgUS3
State (EI)
opportunity.state_ei
TEXT
opportunity
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Name (EI)
opportunity.name_ei
TEXT
opportunity
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Address (EI)
opportunity.address_ei
TEXT
opportunity
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Additional Attorney Notes
opportunity.additional_attorney_notes
LARGE_TEXT
opportunity
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Days Missed
opportunity.days_missed
TEXT
opportunity
jvtRAlDgPlhp58Yy3lHd
ISBA
opportunity.isba
TEXT
opportunity
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Wage
opportunity.wage
TEXT
opportunity
rEjf7RVhji6j9sTcCkxu
Hrs/Wk
opportunity.hrswk
TEXT
opportunity
tcr1SiYAhZTqgaEk7sd5
City (EI)
opportunity.city_ei
TEXT
opportunity
uEXQDElKoenigOJhkhqq
Zip Code (EI)
opportunity.zip_code_ei
TEXT
opportunity
8UoJDHMiDd6OiHLxS1jv
Returned to Work
opportunity.returned_to_work
SINGLE_OPTIONS
opportunity
XMHj7QAXneGqIcXDb4Ru
Transportation Provider Name
opportunity.transportation_provider_name
TEXT
opportunity
3ySgSDSq6p5tu6J6Cqun
Injury Notes
opportunity.injury_notes
LARGE_TEXT
opportunity
FPye5Hrp3AbmyPp2Gi2o
Hospital/EmergencyDates
opportunity.hospitalemergencydates
DATE
opportunity
GiYDJex6WIFchBxyrJBv
Photos of Injuries
opportunity.photos_of_injuries
RADIO
opportunity
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Injuries
opportunity.injuries
LARGE_TEXT
opportunity
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Hospital/Emergency Name
opportunity.hospitalemergency_name
TEXT
opportunity
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Prior Doctors
opportunity.prior_doctors
LARGE_TEXT
opportunity
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Follow-Up Treatment
opportunity.followup_treatment
LARGE_TEXT
opportunity
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Initial Treatment
opportunity.initial_treatment
LARGE_TEXT
opportunity
qIJ4T3ByP8uJdX0aA6oB
Prior Injuries
opportunity.prior_injuries
LARGE_TEXT
opportunity
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Hospital-In Patient
opportunity.hospitalin_patient
SINGLE_OPTIONS
opportunity
ZIZg1VzjGesGfTlMAbOW
Hospital/Emergency
opportunity.hospitalemergency
SINGLE_OPTIONS
opportunity
aqPaS4hNvfas8MOw3q3L
Taken by Ambulance
opportunity.taken_by_ambulance
SINGLE_OPTIONS
opportunity
KqsJ9SppwNWS9oELF8UK
Referral Firm Name
contact.referral_firm_name
TEXT
contact
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Referral Firm Attorney First Name
contact.referral_firm_attorney_first_name
TEXT
contact
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Referral Firm Attorney Last Name
contact.referral_firm_attorney_last_name
TEXT
contact
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Referral Firm Phone Number
contact.referral_firm_phone_number
TEXT
contact
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Referral Firm Website
contact.referral_firm_website
TEXT
contact
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Referral Firm Email
contact.referral_firm_email
TEXT
contact
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Referral Notes
contact.referral_notes
LARGE_TEXT
contact
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Referred Out Status
contact.referred_out_status
TEXT
contact
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Referral Partner
contact.referral_partner
TEXT
contact
xrdIm3kJcXudeLUAWaHQ
Referral Yes/Not Interested Page
contact.referral_yesnot_interested_page
TEXT
contact
jy7SPdrBlepwEmHuPfTh
Referral Status Update Page
contact.referral_status_update_page
TEXT
contact
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Referral Case Resolved Page
contact.referral_case_resolved_page
TEXT
contact
0NKDP7UAEc1Q3iX05G8Y
Counter
contact.counter
NUMERICAL
contact
WP4EfUEuZGlmuMK5M7ED
Referral Case Type
contact.referral_case_type
TEXT
contact
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Secondary Email
contact.secondary_email
TEXT
contact
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Minor Name
contact.minor_name
TEXT
contact
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Attorney Name
contact.attorney_name
TEXT
contact
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Doc Type
contact.doc_type
SINGLE_OPTIONS
contact
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Waived as a result of representing
contact.waived_as_a_result_of_representing
TEXT
contact
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Location of Incident
contact.location_of_incident
TEXT
contact
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Employer
contact.employer
TEXT
contact
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NPS Score 3
contact.nps_score_3
TEXT
contact
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How can we help?
contact.how_can_we_help
SINGLE_OPTIONS
contact
H6otr4Uid6TQsrs0bDER
NPS Level
contact.nps_level
NUMERICAL
contact
HksdP4JJyUZvy6Bbu9KA
Co-Counsel Attorney Name
contact.cocounsel_attorney_name
TEXT
contact
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NPS Score
contact.nps_score
RADIO
contact
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Tell us more!
contact.tell_us_more
LARGE_TEXT
contact
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NPS Score 1
contact.nps_score_1
TEXT
contact
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NPS Score 2
contact.nps_score_2
TEXT
contact
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NPS Score 4
contact.nps_score_4
TEXT
contact
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Case Type
contact.case_type
SINGLE_OPTIONS
contact
xf5DZvdreU3p8jlqFiVN
Reason for rejection (CF)
contact.reason_for_rejection_cf
TEXT
contact
3fYDLrsSbI7wz29o2RsT
How many retainers do you need to set up?
opportunity.how_many_retainers_do_you_need_to_set_up
SINGLE_OPTIONS
opportunity
v3259NfcsQaoQixaxvGs
Macloskey Minor Name-1
opportunity.minor_name1
TEXT
opportunity
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Macloskey Minor Name-2
opportunity.minor_name2
TEXT
opportunity
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Macloskey Minor Name-3
opportunity.minor_name3
TEXT
opportunity
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Macloskey Minor Name-4
opportunity.minor_name4
TEXT
opportunity
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Macloskey Minor Name-5
opportunity.minor_name5
TEXT
opportunity
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Macloskey Minor Name-6
opportunity.minor_name6
TEXT
opportunity
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Waived as a result of representing (full name)-spa1
opportunity.waived_as_a_result_of_representing_full_name1
TEXT
opportunity
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Waived as a result of representing (full name)-spa 2
opportunity.waived_as_a_result_of_representing_full_name2
TEXT
opportunity
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Waived as a result of representing (full name)-spa 3
opportunity.waived_as_a_result_of_representing_full_name3
TEXT
opportunity
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Waived as a result of representing (full name)-spa 4
opportunity.waived_as_a_result_of_representing_full_name4
TEXT
opportunity
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Waived as a result of representing (full name)-spa 5
opportunity.waived_as_a_result_of_representing_full_name5
TEXT
opportunity
KOuNouLJ4myzgLgJ4UTr
Waived as a result of representing (full name)-spa 6
opportunity.waived_as_a_result_of_representing_full_name6
TEXT
opportunity
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Location of incident- Eng 1
opportunity.location_of_incident1
TEXT
opportunity
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Location of incident- Eng 2
opportunity.location_of_incident2
TEXT
opportunity
c5YrGpujlkntBQgqAG1s
Location of incident- Eng 4
opportunity.location_of_incident4
TEXT
opportunity
WbC4spnGbx0xW4wM1U9N
Location of incident- Eng 5
opportunity.location_of_incident5
TEXT
opportunity
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Location of incident- Eng 6
opportunity.location_of_incident6
TEXT
opportunity
BAz05vsI50CFJmJ3TRis
Which agreement do you wish to send?-1
opportunity.which_agreement_do_you_wish_to_send1
CHECKBOX
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Which agreement do you wish to send?-2
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CHECKBOX
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Which agreement do you wish to send?-3
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CHECKBOX
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Which agreement do you wish to send?-4
opportunity.which_agreement_do_you_wish_to_send4
CHECKBOX
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Which agreement do you wish to send?-5
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CHECKBOX
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Which agreement do you wish to send?-6
opportunity.which_agreement_do_you_wish_to_send6
CHECKBOX
opportunity
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Co-Counsel Minor Name -4
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TEXT
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Co-Counsel Minor Name -5
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Co-Counsel Minor Name -6
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opportunity
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Waived as a result of representing (full name)-eng 2
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TEXT
opportunity
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Waived as a result of representing (full name)-eng 1
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TEXT
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Waived as a result of representing (full name)-eng 3
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Waived as a result of representing (full name)-eng 4
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TEXT
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Waived as a result of representing (full name)-eng 5
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TEXT
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Waived as a result of representing (full name)-eng 6
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TEXT
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Location of incident- Spa 1
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TEXT
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Location of incident- Spa 2
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TEXT
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Location of incident- Spa 3
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Location of incident- Spa 4
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Location of incident- Spa 5
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Location of incident- Spa 6
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Location of incident- Eng 3
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Co-Counsel Attorney - 1
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SINGLE_OPTIONS
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Co-Counsel Attorney - 2
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SINGLE_OPTIONS
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Co-Counsel Attorney - 3
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SINGLE_OPTIONS
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Co-Counsel Attorney - 4
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SINGLE_OPTIONS
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Co-Counsel Attorney - 5
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SINGLE_OPTIONS
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Co-Counsel Attorney - 6
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SINGLE_OPTIONS
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Co-Counsel Minor Name -1
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Co-Counsel Minor Name -2
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Co-Counsel Minor Name -3
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Co-Counsel Minor Attorney - 1
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SINGLE_OPTIONS
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Co-Counsel Minor Attorney - 2
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SINGLE_OPTIONS
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Co-Counsel Minor Attorney - 3
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SINGLE_OPTIONS
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Co-Counsel Minor Attorney - 4
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SINGLE_OPTIONS
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Co-Counsel Minor Attorney - 5
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SINGLE_OPTIONS
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Co-Counsel Minor Attorney - 6
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SINGLE_OPTIONS
opportunity
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Black & Jones Attorney -1
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SINGLE_OPTIONS
opportunity
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Black & Jones Attorney -2
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SINGLE_OPTIONS
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Black & Jones Attorney -3
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SINGLE_OPTIONS
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Black & Jones Attorney -4
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SINGLE_OPTIONS
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Black & Jones Attorney -5
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SINGLE_OPTIONS
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Black & Jones Attorney -6
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SINGLE_OPTIONS
opportunity
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Case Evaluation
opportunity.case_evaluation
SINGLE_OPTIONS
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Emergency Contact Address
opportunity.emergency_contact_address
LARGE_TEXT
opportunity
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Date of Incident
contact.date_of_incident
DATE
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NPS Feedback
contact.nps_feedback
LARGE_TEXT
contact
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Liability & Coverage
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SINGLE_OPTIONS
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Case Type
opportunity.case_type
SINGLE_OPTIONS
opportunity
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Treatment
opportunity.treatment
SINGLE_OPTIONS
opportunity
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Injury
opportunity.injury
SINGLE_OPTIONS
opportunity
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Timeframe
opportunity.timeframe
SINGLE_OPTIONS
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Reason for rejection (Decline)
opportunity.reason_for_rejection_decline
SINGLE_OPTIONS
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Reason for Rejection (Decline) - Other notes
opportunity.reason_for_rejection_decline__other_notes
LARGE_TEXT
opportunity
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Intake Report PDF
contact.intake_report_pdf
FILE_UPLOAD
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Preferred Language
opportunity.preferred_language
SINGLE_OPTIONS
opportunity
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Best Form of Contact - Intake Form
contact.best_form_of_contact__intake_form
SINGLE_OPTIONS
contact
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Pronouns - Intake Form
contact.pronouns__intake_form
SINGLE_OPTIONS
contact
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Salutation - Intake Form
contact.salutation__intake_form
SINGLE_OPTIONS
contact
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SSN - Intake Form
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TEXT
contact
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Date of Incident - Intake Form
contact.date_of_incident__intake_form
DATE
contact
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Amount - Intake Form
contact.amount__intake_form
TEXT
contact
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Police Investigated - Intake Form
contact.police_investigated__intake_form
SINGLE_OPTIONS
contact
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Vehicle Location - Intake Form
contact.vehicle_location__intake_form
TEXT
contact
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Witness 1 Phone - Intake Form
contact.witness_1_phone__intake_form
TEXT
contact
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Witness 1 Name - Intake Form
contact.witness_1_name__intake_form
TEXT
contact
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Location - Intake Form
contact.location__intake_form
LARGE_TEXT
contact
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Incident Notes - Intake Form
contact.incident_notes__intake_form
LARGE_TEXT
contact
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Hospital/Emergency Name - Intake Form
contact.hospitalemergency_name__intake_form
TEXT
contact
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Hospital/Emergency Dates - Intake Form
contact.hospitalemergency_dates_intake_form
DATE
contact
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Hospital-In Patient - Intake Form
contact.hospitalin_patient__intake_form
SINGLE_OPTIONS
contact
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Taken by Ambulance - Intake Form
contact.taken_by_ambulance__intake_form
SINGLE_OPTIONS
contact
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Prior Injuries - Intake Form
contact.prior_injuries__intake_form
LARGE_TEXT
contact
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Follow-Up Treatment - Intake Form
contact.followup_treatment__intake_form
LARGE_TEXT
contact
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Employer - Intake Form
contact.employer__intake_form
TEXT
contact
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Address (EI) - Intake Form
contact.address_ei__intake_form
TEXT
contact
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City (EI) - Intake Form
contact.city_ei__intake_form
TEXT
contact
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State (EI) - Intake Form
contact.state_ei__intake_form
TEXT
contact
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Days Missed - Intake Form
contact.days_missed__intake_form
TEXT
contact
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Wage - Intake Form
contact.wage__intake_form
TEXT
contact
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Hrs/Wk - Intake Form
contact.hrswk__intake_form
TEXT
contact
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Returned to Work - Intake Form
contact.returned_to_work__intake_form
SINGLE_OPTIONS
contact
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Contacted by Defendant’s Insurance - Intake Form
contact.contacted_by_defendants_insurance__intake_form
SINGLE_OPTIONS
contact
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Offer Made - Intake Form
contact.offer_made__intake_form
SINGLE_OPTIONS
contact
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Medicare - Intake Form
contact.medicare__intake_form
SINGLE_OPTIONS
contact
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Insurance #1 - Intake Form
contact.insurance_1__intake_form
TEXT
contact
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Insurance Amount - Intake Form
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TEXT
contact
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Defendant #1 - Intake Form
contact.defendant_1__intake_form
TEXT
contact
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Defendant #2 - Intake Form
contact.defendant_2__intake_form
TEXT
contact
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Group Health Insurance - Intake Form
contact.group_health_insurance__intake_form
TEXT
contact
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Policy No - Intake Form
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TEXT
contact
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Lost Wage Claim - Intake Form
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TEXT
contact
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Plaintiff’s Auto Insurance - Intake Form
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contact
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Liability ONLY - Intake Form
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SINGLE_OPTIONS
contact
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Med Pay - Intake Form
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SINGLE_OPTIONS
contact
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Medicaid - Intake Form
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SINGLE_OPTIONS
contact
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Address - Intake Form
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TEXT
contact
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Insurance #2 - Intake Form
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TEXT
contact
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