edit document template- payment receipt

Hello,

Insurance companies/ patients in Holland ask for specific information on their payment receipt. Is this possible to build in (merge field)?.

I cannot creat it by myself because the merge fields I need are not in the options (create merge field).

The information I need on the payment receipt:

–> Patients adress
–> DOB
–> Reference
–> Next appointment

Is it possible to insert this in the merge field options ? When not, can you customize an template for me ?

🙂
Maarten