diff --git a/apps/Frontend/src/components/claims/claim-form.tsx b/apps/Frontend/src/components/claims/claim-form.tsx
index a9e09d08..087b90a7 100755
--- a/apps/Frontend/src/components/claims/claim-form.tsx
+++ b/apps/Frontend/src/components/claims/claim-form.tsx
@@ -1537,6 +1537,8 @@ export function ClaimForm({
       insuranceProvider: "United Ucard",
       appointmentId: appointmentIdToUse,
       insuranceSiteKey: "UNITED_UCARD",
+      firstName: patient?.firstName ?? "",
+      lastName: patient?.lastName ?? "",
       claimId: createdClaim.id,
       claimFiles: claimFilesMeta,
     });
diff --git a/apps/SeleniumService/selenium_UnitedUcard_claimSubmitWorker.py b/apps/SeleniumService/selenium_UnitedUcard_claimSubmitWorker.py
index 2105e1f8..aeeb5941 100644
--- a/apps/SeleniumService/selenium_UnitedUcard_claimSubmitWorker.py
+++ b/apps/SeleniumService/selenium_UnitedUcard_claimSubmitWorker.py
@@ -16,7 +16,7 @@ service lines / attach files / submit / save confirmation PDF) are left as
 TODO stubs — fill these in once we know the exact DOM for the claim
 submission flow on the UHC Dental provider dashboard.
 """
-from selenium.common.exceptions import WebDriverException, TimeoutException
+from selenium.common.exceptions import WebDriverException, TimeoutException, NoSuchElementException
 from selenium.webdriver.common.by import By
 from selenium.webdriver.support.ui import WebDriverWait
 from selenium.webdriver.support import expected_conditions as EC
@@ -382,12 +382,12 @@ class AutomationUnitedUcardClaimSubmit:
 
     def step3_fill_patient_information(self):
         """
-        Fill the Patient Information step: Date of Service, Subscriber ID,
-        Date of Birth, then click Search to look up the member.
+        Fill the Patient Information step: Date of Service, choose the
+        First Name + Last Name + DOB search, then First/Last Name, Date of Birth, then click Search to look up the member.
 
         Confirmed against the live site (2026-09-13):
           <input type="date" class="date-input date-of-service" placeholder="mm/dd/yyyy">
-          <input type="text" class="subscriber-id">
+          <input type="text" class="member-fname"> / <input type="text" class="member-lname">
           <input type="date" class="date-input date-of-birth" placeholder="mm/dd/yyyy">
           <button class="search-button member-search">Search</button>
         """
@@ -402,12 +402,30 @@ class AutomationUnitedUcardClaimSubmit:
             return "ERROR: Date of Service field not found on Patient Information step"
 
         try:
-            subscriber_id_field = self.driver.find_element(By.CSS_SELECTOR, "input.subscriber-id")
-            subscriber_id_field.clear()
-            subscriber_id_field.send_keys(self.memberId)
-            print(f"[UnitedUcard Claim] Entered Subscriber ID: {self.memberId}")
+            name_radio = WebDriverWait(self.driver, 10).until(
+                EC.presence_of_element_located((By.CSS_SELECTOR, "input.searchname[name='member-search'][value='name']"))
+            )
+            self.driver.execute_script("arguments[0].scrollIntoView({block:'center'});", name_radio)
+            try:
+                name_radio.click()
+            except Exception:
+                self.driver.execute_script("arguments[0].click();", name_radio)
+            print("[UnitedUcard Claim] Selected 'First Name + Last Name + DOB' search")
+        except TimeoutException:
+            return "ERROR: 'First Name + Last Name + DOB' radio not found on Patient Information step"
+
+        try:
+            fname_field = WebDriverWait(self.driver, 10).until(
+                EC.element_to_be_clickable((By.CSS_SELECTOR, "input.member-fname"))
+            )
+            fname_field.clear()
+            fname_field.send_keys(self.firstName)
+            lname_field = self.driver.find_element(By.CSS_SELECTOR, "input.member-lname")
+            lname_field.clear()
+            lname_field.send_keys(self.lastName)
+            print(f"[UnitedUcard Claim] Entered name: {self.firstName} {self.lastName}")
         except Exception as e:
-            return f"ERROR: Subscriber ID field not found on Patient Information step: {e}"
+            return f"ERROR: First/Last Name fields not found on Patient Information step: {e}"
 
         try:
             dob_field = self.driver.find_element(By.CSS_SELECTOR, "input.date-of-birth")
@@ -646,6 +664,16 @@ class AutomationUnitedUcardClaimSubmit:
         except TimeoutException:
             return "ERROR: 'Add a Procedure' button not found"
 
+    def _wait_visible(self, element_id, timeout=10):
+        """Return the element once visible, or None if it never appears
+        (the portal only shows tooth fields for certain procedure codes)."""
+        try:
+            return WebDriverWait(self.driver, timeout).until(
+                lambda d: next((e for e in d.find_elements(By.ID, element_id) if e.is_displayed()), None)
+            )
+        except TimeoutException:
+            return None
+
     def _fill_and_save_procedure(self, line: dict, idx: int):
         """
         Fill one procedure row (Procedure Code, Date of Service, Procedure
@@ -690,6 +718,28 @@ class AutomationUnitedUcardClaimSubmit:
         except Exception as e:
             return f"ERROR: Procedure Fee field not found for line {idx + 1}: {e}"
 
+        # Tooth Number / Surface are driven by the app's claim data: only wait
+        # for and fill them when the service line actually has a value.
+        tooth = str(line.get("toothNumber") or line.get("tooth") or "").strip()
+        if tooth:
+            tooth_field = self._wait_visible("toothNum")
+            if tooth_field:
+                tooth_field.clear()
+                tooth_field.send_keys(tooth)
+                print(f"[UnitedUcard Claim] Entered Tooth Number: {tooth}")
+            else:
+                print(f"[UnitedUcard Claim] Tooth Number field did not appear for {procedure_code}; skipped")
+
+        surface = str(line.get("toothSurface") or line.get("surface") or "").strip().upper()
+        if surface:
+            surface_field = self._wait_visible("toothSurf")
+            if surface_field:
+                surface_field.clear()
+                surface_field.send_keys(surface)
+                print(f"[UnitedUcard Claim] Entered Tooth Surface: {surface}")
+            else:
+                print(f"[UnitedUcard Claim] Tooth Surface field did not appear for {procedure_code}; skipped")
+
         try:
             save_btn = WebDriverWait(self.driver, 10).until(
                 EC.element_to_be_clickable((By.XPATH, "//*[@onclick='saveProcCode()']"))