The encounter number is required. The encounter number may not contain the semicolon (';') character. The encounter number may not contain a credit card number.

The patient name is required. The patient name may not contain the semicolon (';') character. The patient name may not contain a credit card number.

The patient date of birth is required. The patient date of birth is not valid. The patient date of birth may not contain a credit card number.

The payment amount is required. The payment amount is not valid. The payment amount may not contain the semicolon (';') character. The payment amount may not contain a credit card number.