File size: 12,278 Bytes

83dfeaf

{
  "</s_10_DOB>": 57915,
  "</s_11_Sex>": 57702,
  "</s_12_AdmissionDate>": 57639,
  "</s_13_AdmissionHour>": 57880,
  "</s_14_AdmissionType>": 57741,
  "</s_15_AdmissionSource>": 57910,
  "</s_16_DischargeHour>": 57564,
  "</s_17_DischargeStatus>": 57628,
  "</s_18_CC>": 57807,
  "</s_19_CC>": 57583,
  "</s_1_BillProvAddr1>": 57663,
  "</s_1_BillProvCity>": 57874,
  "</s_1_BillProvOrgName>": 57652,
  "</s_1_BillProvPhoneNumber>": 57677,
  "</s_1_BillProvPostCode>": 57780,
  "</s_1_BillProvState>": 57866,
  "</s_1_MPAddr1>": 57724,
  "</s_1_MPAddr2>": 57850,
  "</s_1_MPCity>": 57870,
  "</s_1_MPCredential>": 57666,
  "</s_1_MPFullName>": 57860,
  "</s_1_MPFullPost>": 57865,
  "</s_1_MPLName>": 57598,
  "</s_1_MPMI>": 57737,
  "</s_1_MPOrgName>": 57913,
  "</s_1_MPPhoneNumber>": 57662,
  "</s_1_MPPostCode>": 57815,
  "</s_1_MPPostCodeExt>": 57900,
  "</s_1_MPPrefix>": 57645,
  "</s_1_MPState>": 57579,
  "</s_1_MPSuffix>": 57635,
  "</s_1_MPvFName>": 57928,
  "</s_20_CC>": 57934,
  "</s_21_CC>": 57546,
  "</s_22_CC>": 57525,
  "</s_23_CC>": 57888,
  "</s_24_CC>": 57920,
  "</s_25_CC>": 57911,
  "</s_26_CC>": 57950,
  "</s_27_CC>": 57926,
  "</s_28_CC>": 57611,
  "</s_29_AccdtSt>": 57604,
  "</s_2_PayToProvAddr1>": 57916,
  "</s_2_PayToProvAddr2>": 57712,
  "</s_2_PayToProvCity>": 57717,
  "</s_2_PayToProvFedIdCode>": 57560,
  "</s_2_PayToProvFullPost>": 57760,
  "</s_2_PayToProvNPI>": 57940,
  "</s_2_PayToProvOrgName>": 57829,
  "</s_2_PayToProvPhoneNumber>": 57744,
  "</s_2_PayToProvPostCode>": 57715,
  "</s_2_PayToProvPostCodeExt>": 57929,
  "</s_2_PayToProvState>": 57547,
  "</s_31_OccCode>": 57714,
  "</s_31_OccDate>": 57923,
  "</s_32_OccCode>": 57574,
  "</s_32_OccDate>": 57685,
  "</s_33_OccCode>": 57835,
  "</s_33_OccDate>": 57689,
  "</s_34_OccCode>": 57644,
  "</s_34_OccDate>": 57782,
  "</s_35_OccFromDate>": 57890,
  "</s_35_OccSpanCode>": 57859,
  "</s_35_OccThruDate>": 57667,
  "</s_36_OccFromDate>": 57793,
  "</s_36_OccSpanCode>": 57697,
  "</s_36_OccThruDate>": 57742,
  "</s_38_InsAddr1>": 57887,
  "</s_38_InsCity>": 57704,
  "</s_38_InsFName>": 57669,
  "</s_38_InsFullName>": 57808,
  "</s_38_InsFullPost>": 57659,
  "</s_38_InsLName>": 57620,
  "</s_38_InsMI>": 57654,
  "</s_38_InsOrgName>": 57612,
  "</s_38_InsPostCode>": 57938,
  "</s_38_InsPrefix>": 57670,
  "</s_38_InsState>": 57839,
  "</s_38_InsSuffix>": 57709,
  "</s_39_ValueAmount>": 57589,
  "</s_39_ValueCode>": 57790,
  "</s_3_ControlNumber>": 57734,
  "</s_3_MedicalRecordNo>": 57937,
  "</s_40_ValueAmount>": 57591,
  "</s_40_ValueCode>": 57556,
  "</s_41_ValueAmount>": 57563,
  "</s_41_ValueCode>": 57691,
  "</s_42_MedicaidPaidAmount>": 57618,
  "</s_4_TypeofBill>": 57641,
  "</s_50_Payer>": 57905,
  "</s_51_ProvId>": 57791,
  "</s_52_RelInfo>": 57854,
  "</s_53_AsgBen>": 57841,
  "</s_54_PriorPay>": 57843,
  "</s_55_EstAmount>": 57797,
  "</s_56_BillProvNPI>": 57551,
  "</s_56_MPNPI>": 57891,
  "</s_57_BillProvOtherId>": 57819,
  "</s_57_BillProvOtherIdQual>": 57655,
  "</s_58_InsFullName>": 57948,
  "</s_59_InsRel>": 57845,
  "</s_5_BillProvFedIdCode>": 57925,
  "</s_5_MedicaidTaxId>": 57824,
  "</s_60_InsIdCode>": 57613,
  "</s_61_GrpName>": 57577,
  "</s_62_GrpNum>": 57632,
  "</s_63_TreatAutoCode>": 57653,
  "</s_64_DocCtrlNum>": 57917,
  "</s_65_EmpName>": 57918,
  "</s_66_ICDCode>": 57587,
  "</s_67A_ODC>": 57935,
  "</s_67A_ODPOA>": 57732,
  "</s_67B_ODC>": 57740,
  "</s_67B_ODPOA>": 57927,
  "</s_67C_ODC>": 57565,
  "</s_67C_ODPOA>": 57529,
  "</s_67D_ODC>": 57693,
  "</s_67D_ODPOA>": 57686,
  "</s_67E_ODC>": 57601,
  "</s_67E_ODPOA>": 57592,
  "</s_67F_ODC>": 57786,
  "</s_67F_ODPOA>": 57869,
  "</s_67G_ODC>": 57772,
  "</s_67G_ODPOA>": 57877,
  "</s_67H_ODC>": 57634,
  "</s_67H_ODPOA>": 57828,
  "</s_67I_ODC>": 57675,
  "</s_67I_ODPOA>": 57930,
  "</s_67J_ODC>": 57539,
  "</s_67J_ODPOA>": 57921,
  "</s_67K_ODC>": 57543,
  "</s_67K_ODPOA>": 57924,
  "</s_67L_ODC>": 57549,
  "</s_67L_ODPOA>": 57922,
  "</s_67M_ODC>": 57603,
  "</s_67M_ODPOA>": 57755,
  "</s_67N_ODC>": 57889,
  "</s_67N_ODPOA>": 57555,
  "</s_67O_ODC>": 57596,
  "</s_67O_ODPOA>": 57886,
  "</s_67P_ODC>": 57615,
  "</s_67P_ODPOA>": 57833,
  "</s_67Q_ODC>": 57627,
  "</s_67Q_ODPOA>": 57944,
  "</s_67_PrinDiagCode>": 57665,
  "</s_67_PrinPOA>": 57661,
  "</s_68A_Other>": 57864,
  "</s_68B_Other>": 57573,
  "</s_69_AdmDiagCode>": 57946,
  "</s_6_StateCovFrom>": 57851,
  "</s_6_StateCovTo>": 57892,
  "</s_70A_ReasonCode>": 57749,
  "</s_70B_ReasonCode>": 57657,
  "</s_70C_ReasonCode>": 57552,
  "</s_71_PPSCode>": 57600,
  "</s_72A_Ecode>": 57637,
  "</s_72B_Ecode>": 57943,
  "</s_72C_Ecode>": 57550,
  "</s_74A_Code>": 57761,
  "</s_74A_Date>": 57649,
  "</s_74B_Code>": 57846,
  "</s_74B_Date>": 57527,
  "</s_74C_Code>": 57727,
  "</s_74C_Date>": 57897,
  "</s_74D_Code>": 57939,
  "</s_74D_Date>": 57678,
  "</s_74E_Code>": 57548,
  "</s_74E_Date>": 57730,
  "</s_74_PrincipleProcCode>": 57902,
  "</s_74_PrincipleProcDate>": 57581,
  "</s_76_AttProvFName>": 57561,
  "</s_76_AttProvLName>": 57831,
  "</s_76_AttProvNPI>": 57553,
  "</s_76_AttProvOrgName>": 57781,
  "</s_76_AttProvOthId>": 57723,
  "</s_76_AttProvQualId>": 57941,
  "</s_77_OpProvFName>": 57533,
  "</s_77_OpProvLName>": 57681,
  "</s_77_OpProvNPI>": 57777,
  "</s_77_OpProvOrgName>": 57595,
  "</s_77_OpProvOthId>": 57768,
  "</s_77_OpProvQualId>": 57894,
  "</s_78_FName>": 57700,
  "</s_78_LName>": 57872,
  "</s_78_NPI>": 57826,
  "</s_78_NPIQual>": 57557,
  "</s_78_OrgName>": 57785,
  "</s_78_OthId>": 57559,
  "</s_78_QualId>": 57683,
  "</s_79_FName>": 57898,
  "</s_79_LName>": 57687,
  "</s_79_NPI>": 57745,
  "</s_79_NPIQual>": 57771,
  "</s_79_OrgName>": 57578,
  "</s_79_OthId>": 57796,
  "</s_79_QualId>": 57733,
  "</s_80_NYSurCharge>": 57534,
  "</s_81A_Value>": 57710,
  "</s_81B_Ind>": 57792,
  "</s_81B_Value>": 57692,
  "</s_81C_Ind>": 57716,
  "</s_81C_Value>": 57694,
  "</s_81D_Ind>": 57834,
  "</s_81D_Value>": 57822,
  "</s_8_FullName>": 57765,
  "</s_9_Addr1>": 57625,
  "</s_9_City>": 57542,
  "</s_9_PostCode>": 57776,
  "</s_9_State>": 57735,
  "</s_MedicaidAmount>": 57756,
  "</s_OccFromDate>": 57775,
  "</s_OccSpanCode>": 57607,
  "</s_OccThruDate>": 57751,
  "<one>": 57951,
  "<s_10_DOB>": 57584,
  "<s_11_Sex>": 57739,
  "<s_12_AdmissionDate>": 57803,
  "<s_13_AdmissionHour>": 57906,
  "<s_14_AdmissionType>": 57571,
  "<s_15_AdmissionSource>": 57753,
  "<s_16_DischargeHour>": 57763,
  "<s_17_DischargeStatus>": 57569,
  "<s_18_CC>": 57562,
  "<s_19_CC>": 57849,
  "<s_1_BillProvAddr1>": 57931,
  "<s_1_BillProvCity>": 57606,
  "<s_1_BillProvOrgName>": 57895,
  "<s_1_BillProvPhoneNumber>": 57875,
  "<s_1_BillProvPostCode>": 57748,
  "<s_1_BillProvState>": 57832,
  "<s_1_MPAddr1>": 57614,
  "<s_1_MPAddr2>": 57538,
  "<s_1_MPCity>": 57682,
  "<s_1_MPCredential>": 57705,
  "<s_1_MPFullName>": 57535,
  "<s_1_MPFullPost>": 57862,
  "<s_1_MPLName>": 57758,
  "<s_1_MPMI>": 57882,
  "<s_1_MPOrgName>": 57885,
  "<s_1_MPPhoneNumber>": 57558,
  "<s_1_MPPostCode>": 57638,
  "<s_1_MPPostCodeExt>": 57914,
  "<s_1_MPPrefix>": 57936,
  "<s_1_MPState>": 57568,
  "<s_1_MPSuffix>": 57623,
  "<s_1_MPvFName>": 57647,
  "<s_20_CC>": 57701,
  "<s_21_CC>": 57528,
  "<s_22_CC>": 57766,
  "<s_23_CC>": 57779,
  "<s_24_CC>": 57795,
  "<s_25_CC>": 57788,
  "<s_26_CC>": 57609,
  "<s_27_CC>": 57629,
  "<s_28_CC>": 57688,
  "<s_29_AccdtSt>": 57540,
  "<s_2_PayToProvAddr1>": 57575,
  "<s_2_PayToProvAddr2>": 57624,
  "<s_2_PayToProvCity>": 57747,
  "<s_2_PayToProvFedIdCode>": 57844,
  "<s_2_PayToProvFullPost>": 57794,
  "<s_2_PayToProvNPI>": 57738,
  "<s_2_PayToProvOrgName>": 57787,
  "<s_2_PayToProvPhoneNumber>": 57536,
  "<s_2_PayToProvPostCode>": 57593,
  "<s_2_PayToProvPostCodeExt>": 57821,
  "<s_2_PayToProvState>": 57903,
  "<s_31_OccCode>": 57673,
  "<s_31_OccDate>": 57896,
  "<s_32_OccCode>": 57713,
  "<s_32_OccDate>": 57823,
  "<s_33_OccCode>": 57800,
  "<s_33_OccDate>": 57798,
  "<s_34_OccCode>": 57719,
  "<s_34_OccDate>": 57945,
  "<s_35_OccFromDate>": 57586,
  "<s_35_OccSpanCode>": 57725,
  "<s_35_OccThruDate>": 57784,
  "<s_36_OccFromDate>": 57643,
  "<s_36_OccSpanCode>": 57778,
  "<s_36_OccThruDate>": 57698,
  "<s_38_InsAddr1>": 57526,
  "<s_38_InsCity>": 57537,
  "<s_38_InsFName>": 57750,
  "<s_38_InsFullName>": 57825,
  "<s_38_InsFullPost>": 57908,
  "<s_38_InsLName>": 57566,
  "<s_38_InsMI>": 57617,
  "<s_38_InsOrgName>": 57820,
  "<s_38_InsPostCode>": 57651,
  "<s_38_InsPrefix>": 57861,
  "<s_38_InsState>": 57899,
  "<s_38_InsSuffix>": 57619,
  "<s_39_ValueAmount>": 57863,
  "<s_39_ValueCode>": 57729,
  "<s_3_ControlNumber>": 57718,
  "<s_3_MedicalRecordNo>": 57676,
  "<s_40_ValueAmount>": 57855,
  "<s_40_ValueCode>": 57799,
  "<s_41_ValueAmount>": 57759,
  "<s_41_ValueCode>": 57933,
  "<s_42_MedicaidPaidAmount>": 57801,
  "<s_4_TypeofBill>": 57706,
  "<s_50_Payer>": 57942,
  "<s_51_ProvId>": 57876,
  "<s_52_RelInfo>": 57648,
  "<s_53_AsgBen>": 57817,
  "<s_54_PriorPay>": 57813,
  "<s_55_EstAmount>": 57585,
  "<s_56_BillProvNPI>": 57590,
  "<s_56_MPNPI>": 57576,
  "<s_57_BillProvOtherId>": 57804,
  "<s_57_BillProvOtherIdQual>": 57672,
  "<s_58_InsFullName>": 57531,
  "<s_59_InsRel>": 57893,
  "<s_5_BillProvFedIdCode>": 57856,
  "<s_5_MedicaidTaxId>": 57640,
  "<s_60_InsIdCode>": 57783,
  "<s_61_GrpName>": 57830,
  "<s_62_GrpNum>": 57631,
  "<s_63_TreatAutoCode>": 57541,
  "<s_64_DocCtrlNum>": 57881,
  "<s_65_EmpName>": 57909,
  "<s_66_ICDCode>": 57674,
  "<s_67A_ODC>": 57907,
  "<s_67A_ODPOA>": 57837,
  "<s_67B_ODC>": 57912,
  "<s_67B_ODPOA>": 57810,
  "<s_67C_ODC>": 57532,
  "<s_67C_ODPOA>": 57544,
  "<s_67D_ODC>": 57838,
  "<s_67D_ODPOA>": 57696,
  "<s_67E_ODC>": 57594,
  "<s_67E_ODPOA>": 57901,
  "<s_67F_ODC>": 57816,
  "<s_67F_ODPOA>": 57711,
  "<s_67G_ODC>": 57582,
  "<s_67G_ODPOA>": 57664,
  "<s_67H_ODC>": 57554,
  "<s_67H_ODPOA>": 57708,
  "<s_67I_ODC>": 57836,
  "<s_67I_ODPOA>": 57570,
  "<s_67J_ODC>": 57630,
  "<s_67J_ODPOA>": 57767,
  "<s_67K_ODC>": 57904,
  "<s_67K_ODPOA>": 57762,
  "<s_67L_ODC>": 57867,
  "<s_67L_ODPOA>": 57852,
  "<s_67M_ODC>": 57789,
  "<s_67M_ODPOA>": 57802,
  "<s_67N_ODC>": 57809,
  "<s_67N_ODPOA>": 57757,
  "<s_67O_ODC>": 57671,
  "<s_67O_ODPOA>": 57773,
  "<s_67P_ODC>": 57621,
  "<s_67P_ODPOA>": 57873,
  "<s_67Q_ODC>": 57842,
  "<s_67Q_ODPOA>": 57703,
  "<s_67_PrinDiagCode>": 57754,
  "<s_67_PrinPOA>": 57656,
  "<s_68A_Other>": 57680,
  "<s_68B_Other>": 57752,
  "<s_69_AdmDiagCode>": 57919,
  "<s_6_StateCovFrom>": 57599,
  "<s_6_StateCovTo>": 57660,
  "<s_70A_ReasonCode>": 57699,
  "<s_70B_ReasonCode>": 57658,
  "<s_70C_ReasonCode>": 57679,
  "<s_71_PPSCode>": 57597,
  "<s_72A_Ecode>": 57642,
  "<s_72B_Ecode>": 57622,
  "<s_72C_Ecode>": 57858,
  "<s_74A_Code>": 57530,
  "<s_74A_Date>": 57868,
  "<s_74B_Code>": 57707,
  "<s_74B_Date>": 57932,
  "<s_74C_Code>": 57588,
  "<s_74C_Date>": 57545,
  "<s_74D_Code>": 57580,
  "<s_74D_Date>": 57726,
  "<s_74E_Code>": 57728,
  "<s_74E_Date>": 57774,
  "<s_74_PrincipleProcCode>": 57827,
  "<s_74_PrincipleProcDate>": 57847,
  "<s_76_AttProvFName>": 57646,
  "<s_76_AttProvLName>": 57848,
  "<s_76_AttProvNPI>": 57840,
  "<s_76_AttProvOrgName>": 57812,
  "<s_76_AttProvOthId>": 57805,
  "<s_76_AttProvQualId>": 57764,
  "<s_77_OpProvFName>": 57857,
  "<s_77_OpProvLName>": 57818,
  "<s_77_OpProvNPI>": 57616,
  "<s_77_OpProvOrgName>": 57878,
  "<s_77_OpProvOthId>": 57871,
  "<s_77_OpProvQualId>": 57879,
  "<s_78_FName>": 57770,
  "<s_78_LName>": 57690,
  "<s_78_NPI>": 57572,
  "<s_78_NPIQual>": 57769,
  "<s_78_OrgName>": 57743,
  "<s_78_OthId>": 57736,
  "<s_78_QualId>": 57626,
  "<s_79_FName>": 57668,
  "<s_79_LName>": 57684,
  "<s_79_NPI>": 57567,
  "<s_79_NPIQual>": 57633,
  "<s_79_OrgName>": 57605,
  "<s_79_OthId>": 57853,
  "<s_79_QualId>": 57814,
  "<s_80_NYSurCharge>": 57746,
  "<s_81A_Value>": 57636,
  "<s_81B_Ind>": 57884,
  "<s_81B_Value>": 57695,
  "<s_81C_Ind>": 57650,
  "<s_81C_Value>": 57811,
  "<s_81D_Ind>": 57806,
  "<s_81D_Value>": 57602,
  "<s_8_FullName>": 57720,
  "<s_9_Addr1>": 57883,
  "<s_9_City>": 57722,
  "<s_9_PostCode>": 57731,
  "<s_9_State>": 57949,
  "<s_MedicaidAmount>": 57721,
  "<s_OccFromDate>": 57610,
  "<s_OccSpanCode>": 57947,
  "<s_OccThruDate>": 57608,
  "<s_iitcdip>": 57523,
  "<s_synthdog>": 57524,
  "<sep/>": 57522,
  "[BLANK]": 57952
}