|
{ |
|
"</s_10A_N>": 57819, |
|
"</s_10A_Y>": 57624, |
|
"</s_10B_N>": 57740, |
|
"</s_10B_Y>": 57861, |
|
"</s_10C_N>": 57720, |
|
"</s_10C_Y>": 57795, |
|
"</s_10D_CC>": 57744, |
|
"</s_11A_DOB>": 57875, |
|
"</s_11B_Code>": 57766, |
|
"</s_11B_Qual>": 57836, |
|
"</s_11C_Name>": 57717, |
|
"</s_11D_N>": 57853, |
|
"</s_11D_Y>": 57544, |
|
"</s_11_Grp_Num>": 57537, |
|
"</s_12_Sign>": 57884, |
|
"</s_13_Sign>": 57752, |
|
"</s_14_Date>": 57527, |
|
"</s_14_Qual>": 57767, |
|
"</s_15_Date>": 57754, |
|
"</s_17A_Id>": 57653, |
|
"</s_17A_Qual>": 57719, |
|
"</s_17B_NPI>": 57657, |
|
"</s_17_Name>": 57584, |
|
"</s_17_OrgName>": 57599, |
|
"</s_19A_Cred>": 57679, |
|
"</s_19A_FName>": 57895, |
|
"</s_19A_Lname>": 57662, |
|
"</s_19A_MI>": 57549, |
|
"</s_19A_Prefix>": 57711, |
|
"</s_19A_Qual>": 57557, |
|
"</s_19A_Suffix>": 57739, |
|
"</s_19B_Cred>": 57658, |
|
"</s_19B_FName>": 57755, |
|
"</s_19B_Lname>": 57823, |
|
"</s_19B_MI>": 57554, |
|
"</s_19B_Prefix>": 57765, |
|
"</s_19B_Qual>": 57691, |
|
"</s_19B_Suffix>": 57788, |
|
"</s_19_Use>": 57764, |
|
"</s_1A_ID>": 57681, |
|
"</s_21_Description>": 57605, |
|
"</s_21_DiagCode>": 57615, |
|
"</s_21_ICDInd>": 57578, |
|
"</s_22_Code>": 57886, |
|
"</s_22_RefNum>": 57577, |
|
"</s_23_AuthNum>": 57863, |
|
"</s_24A_FromDate>": 57693, |
|
"</s_24A_ToDate>": 57667, |
|
"</s_24B_POS>": 57873, |
|
"</s_24C_EMG>": 57595, |
|
"</s_24D_Modifier>": 57529, |
|
"</s_24D_ProcCode>": 57857, |
|
"</s_24E_DiagPtr>": 57826, |
|
"</s_24F_LineCharges>": 57845, |
|
"</s_24G_Units>": 57888, |
|
"</s_24H_EPSDT1>": 57627, |
|
"</s_24H_EPSDT>": 57611, |
|
"</s_24J_NPIId>": 57548, |
|
"</s_24J_OtherId>": 57716, |
|
"</s_24_Amount>": 57778, |
|
"</s_24_Charge>": 57647, |
|
"</s_24_HCT>": 57801, |
|
"</s_24_Med_Amount>": 57700, |
|
"</s_24_NDC>": 57687, |
|
"</s_24_NDCUnits>": 57553, |
|
"</s_24_NDCUnitsQual>": 57820, |
|
"</s_24_ProcDesc>": 57871, |
|
"</s_24_TaxAmount>": 57663, |
|
"</s_25_Code>": 57660, |
|
"</s_25_EIN>": 57854, |
|
"</s_25_SSN>": 57632, |
|
"</s_26_PatAcctNo>": 57868, |
|
"</s_27_N>": 57646, |
|
"</s_27_Y>": 57818, |
|
"</s_28_TotalCharges>": 57563, |
|
"</s_29_AmountPaid>": 57730, |
|
"</s_2_PatName>": 57670, |
|
"</s_31_Code>": 57685, |
|
"</s_31_FullName>": 57695, |
|
"</s_31_OrgName>": 57650, |
|
"</s_32_Addr1>": 57731, |
|
"</s_32_Addr2>": 57629, |
|
"</s_32_City>": 57561, |
|
"</s_32_Cred>": 57807, |
|
"</s_32_Fname>": 57579, |
|
"</s_32_FullPost>": 57530, |
|
"</s_32_Lname>": 57601, |
|
"</s_32_MI>": 57736, |
|
"</s_32_MedTexId>": 57747, |
|
"</s_32_NPIId>": 57533, |
|
"</s_32_OrgName>": 57793, |
|
"</s_32_OtherId>": 57879, |
|
"</s_32_OtherIdFull>": 57547, |
|
"</s_32_PostCode5>": 57850, |
|
"</s_32_PostCode>": 57623, |
|
"</s_32_PostCodeExt>": 57837, |
|
"</s_32_Prefix>": 57573, |
|
"</s_32_ProgOrgName>": 57781, |
|
"</s_32_ProvAddr1>": 57591, |
|
"</s_32_ProvCity>": 57852, |
|
"</s_32_ProvCred>": 57596, |
|
"</s_32_ProvFName>": 57864, |
|
"</s_32_ProvLName>": 57614, |
|
"</s_32_ProvMI>": 57684, |
|
"</s_32_ProvNPIId>": 57631, |
|
"</s_32_ProvOtherId>": 57816, |
|
"</s_32_ProvOtherIdFull>": 57651, |
|
"</s_32_ProvPostCode>": 57558, |
|
"</s_32_ProvPrefix>": 57690, |
|
"</s_32_ProvState>": 57565, |
|
"</s_32_ProvSuffix>": 57551, |
|
"</s_32_State>": 57673, |
|
"</s_32_Suffix>": 57735, |
|
"</s_33_Addr1>": 57589, |
|
"</s_33_City>": 57555, |
|
"</s_33_FullName>": 57564, |
|
"</s_33_MCTaxId>": 57885, |
|
"</s_33_MPAddr1>": 57748, |
|
"</s_33_MPAddr2>": 57794, |
|
"</s_33_MPCity>": 57896, |
|
"</s_33_MPCred>": 57616, |
|
"</s_33_MPFName>": 57725, |
|
"</s_33_MPFullPost>": 57738, |
|
"</s_33_MPLName>": 57741, |
|
"</s_33_MPMI>": 57669, |
|
"</s_33_MPNPIId>": 57672, |
|
"</s_33_MPOrgName>": 57844, |
|
"</s_33_MPOtherId>": 57708, |
|
"</s_33_MPOtheridFull>": 57678, |
|
"</s_33_MPPhone>": 57783, |
|
"</s_33_MPPostCode5>": 57830, |
|
"</s_33_MPPostCode>": 57798, |
|
"</s_33_MPPostCodeExt>": 57594, |
|
"</s_33_MPPrefix>": 57759, |
|
"</s_33_MPState>": 57877, |
|
"</s_33_MPSuffix>": 57849, |
|
"</s_33_NPIId>": 57552, |
|
"</s_33_OrgName>": 57574, |
|
"</s_33_OtherId>": 57664, |
|
"</s_33_Phone>": 57856, |
|
"</s_33_PostCode>": 57644, |
|
"</s_33_State>": 57528, |
|
"</s_3_Due>": 57694, |
|
"</s_3_F>": 57696, |
|
"</s_3_M>": 57710, |
|
"</s_3_PatDOB>": 57559, |
|
"</s_4_FullName>": 57603, |
|
"</s_5_PatAddr1>": 57817, |
|
"</s_5_PatCity>": 57846, |
|
"</s_5_PatPhone>": 57699, |
|
"</s_5_PatPostCode>": 57703, |
|
"</s_5_PatState>": 57761, |
|
"</s_6_PatRelShipChild>": 57706, |
|
"</s_6_PatRelShipOther>": 57859, |
|
"</s_6_PatRelShipSelf>": 57825, |
|
"</s_6_PatRelShipSpouse>": 57827, |
|
"</s_7_PriInsAddr1>": 57756, |
|
"</s_7_PriInsCity>": 57775, |
|
"</s_7_PriInsPhoneNumber>": 57630, |
|
"</s_7_PriInsPostCode>": 57718, |
|
"</s_7_PriInsState>": 57763, |
|
"</s_8_PatEmpStatusCode>": 57592, |
|
"</s_8_PatStatus>": 57656, |
|
"</s_8_PatStatusMarried>": 57881, |
|
"</s_8_PatStatusOther>": 57779, |
|
"</s_8_PatStatusSingle>": 57786, |
|
"</s_8_PatStudent>": 57777, |
|
"</s_8_PatStudentStatusCodeFT>": 57677, |
|
"</s_8_PatStudentStatusCodePT>": 57812, |
|
"</s_9A_SecInsPolGrpNumber>": 57643, |
|
"</s_9B_SecInsDOB>": 57606, |
|
"</s_9B_SecInsSexF>": 57668, |
|
"</s_9B_SecInsSexM>": 57697, |
|
"</s_9D_SecInsPlanName>": 57608, |
|
"</s_9_SecInsFName>": 57556, |
|
"</s_9_SecInsFullName>": 57872, |
|
"</s_9_SecInsLName>": 57617, |
|
"</s_9_SecInsMI>": 57742, |
|
"</s_9_SecInsPrefix>": 57639, |
|
"</s_9_SecInsSuffix>": 57538, |
|
"</s_Box19A_NPI>": 57762, |
|
"</s_Box19A_Provider>": 57797, |
|
"</s_Box19A_QQ>": 57665, |
|
"</s_Box19B_NPI>": 57682, |
|
"</s_Box19B_Provider>": 57701, |
|
"</s_MissApp>": 57809, |
|
"<XLT>": 57897, |
|
"<one>": 57898, |
|
"<s_10A_N>": 57689, |
|
"<s_10A_Y>": 57713, |
|
"<s_10B_N>": 57638, |
|
"<s_10B_Y>": 57891, |
|
"<s_10C_N>": 57769, |
|
"<s_10C_Y>": 57633, |
|
"<s_10D_CC>": 57674, |
|
"<s_11A_DOB>": 57582, |
|
"<s_11B_Code>": 57892, |
|
"<s_11B_Qual>": 57821, |
|
"<s_11C_Name>": 57838, |
|
"<s_11D_N>": 57675, |
|
"<s_11D_Y>": 57792, |
|
"<s_11_Grp_Num>": 57571, |
|
"<s_12_Sign>": 57541, |
|
"<s_13_Sign>": 57618, |
|
"<s_14_Date>": 57724, |
|
"<s_14_Qual>": 57625, |
|
"<s_15_Date>": 57760, |
|
"<s_17A_Id>": 57841, |
|
"<s_17A_Qual>": 57771, |
|
"<s_17B_NPI>": 57785, |
|
"<s_17_Name>": 57814, |
|
"<s_17_OrgName>": 57790, |
|
"<s_19A_Cred>": 57635, |
|
"<s_19A_FName>": 57894, |
|
"<s_19A_Lname>": 57874, |
|
"<s_19A_MI>": 57535, |
|
"<s_19A_Prefix>": 57734, |
|
"<s_19A_Qual>": 57745, |
|
"<s_19A_Suffix>": 57750, |
|
"<s_19B_Cred>": 57791, |
|
"<s_19B_FName>": 57655, |
|
"<s_19B_Lname>": 57803, |
|
"<s_19B_MI>": 57654, |
|
"<s_19B_Prefix>": 57570, |
|
"<s_19B_Qual>": 57805, |
|
"<s_19B_Suffix>": 57704, |
|
"<s_19_Use>": 57715, |
|
"<s_1A_ID>": 57829, |
|
"<s_21_Description>": 57810, |
|
"<s_21_DiagCode>": 57581, |
|
"<s_21_ICDInd>": 57808, |
|
"<s_22_Code>": 57590, |
|
"<s_22_RefNum>": 57526, |
|
"<s_23_AuthNum>": 57531, |
|
"<s_24A_FromDate>": 57692, |
|
"<s_24A_ToDate>": 57597, |
|
"<s_24B_POS>": 57832, |
|
"<s_24C_EMG>": 57607, |
|
"<s_24D_Modifier>": 57612, |
|
"<s_24D_ProcCode>": 57727, |
|
"<s_24E_DiagPtr>": 57834, |
|
"<s_24F_LineCharges>": 57787, |
|
"<s_24G_Units>": 57876, |
|
"<s_24H_EPSDT1>": 57676, |
|
"<s_24H_EPSDT>": 57637, |
|
"<s_24J_NPIId>": 57733, |
|
"<s_24J_OtherId>": 57645, |
|
"<s_24_Amount>": 57800, |
|
"<s_24_Charge>": 57588, |
|
"<s_24_HCT>": 57712, |
|
"<s_24_Med_Amount>": 57866, |
|
"<s_24_NDC>": 57751, |
|
"<s_24_NDCUnits>": 57880, |
|
"<s_24_NDCUnitsQual>": 57774, |
|
"<s_24_ProcDesc>": 57652, |
|
"<s_24_TaxAmount>": 57568, |
|
"<s_25_Code>": 57768, |
|
"<s_25_EIN>": 57545, |
|
"<s_25_SSN>": 57586, |
|
"<s_26_PatAcctNo>": 57867, |
|
"<s_27_N>": 57811, |
|
"<s_27_Y>": 57562, |
|
"<s_28_TotalCharges>": 57702, |
|
"<s_29_AmountPaid>": 57789, |
|
"<s_2_PatName>": 57728, |
|
"<s_31_Code>": 57815, |
|
"<s_31_FullName>": 57824, |
|
"<s_31_OrgName>": 57540, |
|
"<s_32_Addr1>": 57680, |
|
"<s_32_Addr2>": 57649, |
|
"<s_32_City>": 57542, |
|
"<s_32_Cred>": 57726, |
|
"<s_32_Fname>": 57709, |
|
"<s_32_FullPost>": 57619, |
|
"<s_32_Lname>": 57621, |
|
"<s_32_MI>": 57772, |
|
"<s_32_MedTexId>": 57598, |
|
"<s_32_NPIId>": 57722, |
|
"<s_32_OrgName>": 57705, |
|
"<s_32_OtherId>": 57671, |
|
"<s_32_OtherIdFull>": 57539, |
|
"<s_32_PostCode5>": 57560, |
|
"<s_32_PostCode>": 57746, |
|
"<s_32_PostCodeExt>": 57851, |
|
"<s_32_Prefix>": 57546, |
|
"<s_32_ProgOrgName>": 57686, |
|
"<s_32_ProvAddr1>": 57532, |
|
"<s_32_ProvCity>": 57620, |
|
"<s_32_ProvCred>": 57743, |
|
"<s_32_ProvFName>": 57770, |
|
"<s_32_ProvLName>": 57843, |
|
"<s_32_ProvMI>": 57887, |
|
"<s_32_ProvNPIId>": 57593, |
|
"<s_32_ProvOtherId>": 57776, |
|
"<s_32_ProvOtherIdFull>": 57567, |
|
"<s_32_ProvPostCode>": 57626, |
|
"<s_32_ProvPrefix>": 57648, |
|
"<s_32_ProvState>": 57729, |
|
"<s_32_ProvSuffix>": 57757, |
|
"<s_32_State>": 57840, |
|
"<s_32_Suffix>": 57666, |
|
"<s_33_Addr1>": 57883, |
|
"<s_33_City>": 57842, |
|
"<s_33_FullName>": 57604, |
|
"<s_33_MCTaxId>": 57835, |
|
"<s_33_MPAddr1>": 57737, |
|
"<s_33_MPAddr2>": 57847, |
|
"<s_33_MPCity>": 57806, |
|
"<s_33_MPCred>": 57688, |
|
"<s_33_MPFName>": 57575, |
|
"<s_33_MPFullPost>": 57583, |
|
"<s_33_MPLName>": 57813, |
|
"<s_33_MPMI>": 57831, |
|
"<s_33_MPNPIId>": 57784, |
|
"<s_33_MPOrgName>": 57707, |
|
"<s_33_MPOtherId>": 57862, |
|
"<s_33_MPOtheridFull>": 57860, |
|
"<s_33_MPPhone>": 57683, |
|
"<s_33_MPPostCode5>": 57878, |
|
"<s_33_MPPostCode>": 57848, |
|
"<s_33_MPPostCodeExt>": 57796, |
|
"<s_33_MPPrefix>": 57569, |
|
"<s_33_MPState>": 57893, |
|
"<s_33_MPSuffix>": 57822, |
|
"<s_33_NPIId>": 57602, |
|
"<s_33_OrgName>": 57642, |
|
"<s_33_OtherId>": 57855, |
|
"<s_33_Phone>": 57641, |
|
"<s_33_PostCode>": 57550, |
|
"<s_33_State>": 57628, |
|
"<s_3_Due>": 57865, |
|
"<s_3_F>": 57889, |
|
"<s_3_M>": 57640, |
|
"<s_3_PatDOB>": 57525, |
|
"<s_4_FullName>": 57613, |
|
"<s_5_PatAddr1>": 57534, |
|
"<s_5_PatCity>": 57572, |
|
"<s_5_PatPhone>": 57833, |
|
"<s_5_PatPostCode>": 57610, |
|
"<s_5_PatState>": 57890, |
|
"<s_6_PatRelShipChild>": 57600, |
|
"<s_6_PatRelShipOther>": 57576, |
|
"<s_6_PatRelShipSelf>": 57585, |
|
"<s_6_PatRelShipSpouse>": 57661, |
|
"<s_7_PriInsAddr1>": 57636, |
|
"<s_7_PriInsCity>": 57721, |
|
"<s_7_PriInsPhoneNumber>": 57869, |
|
"<s_7_PriInsPostCode>": 57732, |
|
"<s_7_PriInsState>": 57870, |
|
"<s_8_PatEmpStatusCode>": 57609, |
|
"<s_8_PatStatus>": 57622, |
|
"<s_8_PatStatusMarried>": 57753, |
|
"<s_8_PatStatusOther>": 57634, |
|
"<s_8_PatStatusSingle>": 57698, |
|
"<s_8_PatStudent>": 57543, |
|
"<s_8_PatStudentStatusCodeFT>": 57780, |
|
"<s_8_PatStudentStatusCodePT>": 57714, |
|
"<s_9A_SecInsPolGrpNumber>": 57858, |
|
"<s_9B_SecInsDOB>": 57828, |
|
"<s_9B_SecInsSexF>": 57839, |
|
"<s_9B_SecInsSexM>": 57723, |
|
"<s_9D_SecInsPlanName>": 57799, |
|
"<s_9_SecInsFName>": 57782, |
|
"<s_9_SecInsFullName>": 57773, |
|
"<s_9_SecInsLName>": 57536, |
|
"<s_9_SecInsMI>": 57659, |
|
"<s_9_SecInsPrefix>": 57580, |
|
"<s_9_SecInsSuffix>": 57882, |
|
"<s_Box19A_NPI>": 57758, |
|
"<s_Box19A_Provider>": 57587, |
|
"<s_Box19A_QQ>": 57802, |
|
"<s_Box19B_NPI>": 57566, |
|
"<s_Box19B_Provider>": 57804, |
|
"<s_MissApp>": 57749, |
|
"<s_iitcdip>": 57523, |
|
"<s_synthdog>": 57524, |
|
"<sep/>": 57522, |
|
"[BLANK]": 57899 |
|
} |
|
|