| { | |
| "</s_10A_PatConditionEmpN>": 57603, | |
| "</s_10A_PatConditionEmpY>": 57605, | |
| "</s_10B_PatAAState>": 57537, | |
| "</s_10B_PatConditionAutoN>": 57679, | |
| "</s_10B_PatConditionAutoY>": 57577, | |
| "</s_10C_PatConditionOtherN>": 57678, | |
| "</s_10C_PatConditionOtherY>": 57775, | |
| "</s_10D_ClaimCodes>": 57720, | |
| "</s_11A_PriInsDOB>": 57699, | |
| "</s_11A_PriInsSexF>": 57527, | |
| "</s_11A_PriInsSexM>": 57668, | |
| "</s_11B_OtherClaimIdCode>": 57717, | |
| "</s_11B_OtherClaimIdCodeQual>": 57609, | |
| "</s_11B_PriInsEmpName>": 57800, | |
| "</s_11C_PriInsPlanName>": 57798, | |
| "</s_11D_PriInsOtherPlanN>": 57643, | |
| "</s_11D_PriInsOtherPlanY>": 57795, | |
| "</s_11_PriInsPolGrpNumber>": 57568, | |
| "</s_12_PatSignonFile>": 57640, | |
| "</s_13_PriSignonFileList>": 57670, | |
| "</s_14_PatCurrentDate>": 57675, | |
| "</s_14_PatCurrentDateQual>": 57806, | |
| "</s_15_PatFirstDateOfIll>": 57582, | |
| "</s_15_PatFirstDateOfIllQual>": 57627, | |
| "</s_16_PatUTWFromDate>": 57636, | |
| "</s_16_PatUTWToDate>": 57814, | |
| "</s_17A_RefProvOtherId>": 57835, | |
| "</s_17A_RefProvOtherIdQual>": 57808, | |
| "</s_17B_RefProvNPI>": 57838, | |
| "</s_17_RefProvFullName>": 57673, | |
| "</s_17_RefProvFullNameQual>": 57735, | |
| "</s_17_RefProvOrgName>": 57748, | |
| "</s_18_PatHospFromDate>": 57622, | |
| "</s_18_PatHospToDate>": 57561, | |
| "</s_19_LocalUse>": 57777, | |
| "</s_19_LocalUsePrefix>": 57534, | |
| "</s_1A_PriInsIDNumber>": 57548, | |
| "</s_20_OSLabCharges>": 57758, | |
| "</s_20_OSLabN>": 57542, | |
| "</s_20_OSLabY>": 57715, | |
| "</s_21_DiagCode>": 57763, | |
| "</s_21_DiagDescription>": 57770, | |
| "</s_21_ICDInd>": 57550, | |
| "</s_22_MedicaidCode>": 57754, | |
| "</s_22_MedicaidRefNum>": 57658, | |
| "</s_23_PriorAuthNum>": 57630, | |
| "</s_24A_FromDate>": 57711, | |
| "</s_24A_ToDate>": 57638, | |
| "</s_24B_POS>": 57745, | |
| "</s_24C_EMG>": 57595, | |
| "</s_24D_Modifier>": 57752, | |
| "</s_24D_ProcCode>": 57753, | |
| "</s_24E_DiagPtr>": 57688, | |
| "</s_24F_LineCharges>": 57680, | |
| "</s_24G_Units>": 57702, | |
| "</s_24H_EPSDT>": 57812, | |
| "</s_24J_RenProvFullName>": 57732, | |
| "</s_24J_RenProvNPIId>": 57610, | |
| "</s_24J_RenProvOtherId>": 57671, | |
| "</s_24J_RenProvOtherIdQual>": 57551, | |
| "</s_24_AnesEndTime>": 57620, | |
| "</s_24_AnesMod>": 57631, | |
| "</s_24_AnesStartTime>": 57596, | |
| "</s_24_AnesTotalMin>": 57833, | |
| "</s_24_AnesTotalTime>": 57837, | |
| "</s_24_AnesUnits>": 57564, | |
| "</s_24_ClmDiscountAmount>": 57773, | |
| "</s_24_ClmNYSurChargeAmount>": 57559, | |
| "</s_24_ClmTaxAmount>": 57761, | |
| "</s_24_HCT>": 57632, | |
| "</s_24_MedicaidPaidAmount>": 57600, | |
| "</s_24_NDC>": 57821, | |
| "</s_24_NDCCharges>": 57685, | |
| "</s_24_NDCQualifier>": 57684, | |
| "</s_24_NDCUnits>": 57585, | |
| "</s_24_NDCUnitsQual>": 57706, | |
| "</s_24_ProcDesc>": 57604, | |
| "</s_25_BillProvEIN>": 57594, | |
| "</s_25_BillProvFedIdCode>": 57825, | |
| "</s_25_BillProvSSN>": 57691, | |
| "</s_26_PatAcctNo>": 57707, | |
| "</s_27_AcceptAssignmentN>": 57827, | |
| "</s_27_AcceptAssignmentY>": 57649, | |
| "</s_28_TotalCharges>": 57563, | |
| "</s_29_AmountPaid>": 57618, | |
| "</s_2_PatFullName>": 57689, | |
| "</s_30_BalanceDue>": 57792, | |
| "</s_31_PrnRenProvFullName>": 57644, | |
| "</s_31_RenDateSigned>": 57725, | |
| "</s_31_RenProvOrgName>": 57584, | |
| "</s_31_RenProvTaxonomyCode>": 57549, | |
| "</s_32_AmbToFacProvAddr1>": 57625, | |
| "</s_32_AmbToFacProvCity>": 57710, | |
| "</s_32_AmbToFacProvFullName>": 57701, | |
| "</s_32_AmbToFacProvNPIId>": 57741, | |
| "</s_32_AmbToFacProvOrgName>": 57589, | |
| "</s_32_AmbToFacProvOtherIdFull>": 57750, | |
| "</s_32_AmbToFacProvPostCode>": 57700, | |
| "</s_32_AmbToFacProvPostCodeExt>": 57778, | |
| "</s_32_AmbToFacProvState>": 57652, | |
| "</s_32_FacProvAddr1>": 57607, | |
| "</s_32_FacProvCity>": 57695, | |
| "</s_32_FacProvFullName>": 57791, | |
| "</s_32_FacProvNPIId>": 57571, | |
| "</s_32_FacProvOrgName>": 57570, | |
| "</s_32_FacProvOtherIdFull>": 57796, | |
| "</s_32_FacProvPostCode>": 57583, | |
| "</s_32_FacProvState>": 57602, | |
| "</s_32_MedicaidTaxId>": 57787, | |
| "</s_33_BillProvAddr1>": 57535, | |
| "</s_33_BillProvCity>": 57562, | |
| "</s_33_BillProvFullName>": 57642, | |
| "</s_33_BillProvNPIId>": 57742, | |
| "</s_33_BillProvOrgName>": 57662, | |
| "</s_33_BillProvOtherIdFull>": 57793, | |
| "</s_33_BillProvPhone>": 57805, | |
| "</s_33_BillProvPostCode>": 57656, | |
| "</s_33_BillProvState>": 57553, | |
| "</s_33_MediBillProvAddr1>": 57703, | |
| "</s_33_MediBillProvCity>": 57629, | |
| "</s_33_MediBillProvNPIId>": 57674, | |
| "</s_33_MediBillProvOrgName>": 57614, | |
| "</s_33_MediBillProvOtherIdFull>": 57768, | |
| "</s_33_MediBillProvPhone>": 57692, | |
| "</s_33_MediBillProvPostCode>": 57705, | |
| "</s_33_MediBillProvState>": 57782, | |
| "</s_33_MedicaidTaxId>": 57822, | |
| "</s_3_PatDOB>": 57650, | |
| "</s_3_PatSexF>": 57592, | |
| "</s_3_PatSexM>": 57687, | |
| "</s_4_PriInsFullName>": 57556, | |
| "</s_5_PatAddr1>": 57693, | |
| "</s_5_PatCity>": 57565, | |
| "</s_5_PatPhoneNumber>": 57788, | |
| "</s_5_PatPostCode>": 57560, | |
| "</s_5_PatState>": 57667, | |
| "</s_6_PatRelShipChild>": 57803, | |
| "</s_6_PatRelShipOther>": 57545, | |
| "</s_6_PatRelShipSelf>": 57712, | |
| "</s_6_PatRelShipSpouse>": 57526, | |
| "</s_7_PriInsAddr1>": 57786, | |
| "</s_7_PriInsCity>": 57660, | |
| "</s_7_PriInsPhoneNumber>": 57580, | |
| "</s_7_PriInsPostCode>": 57824, | |
| "</s_7_PriInsState>": 57755, | |
| "</s_8_PatEmpStatusCode>": 57734, | |
| "</s_8_PatStatusMarried>": 57830, | |
| "</s_8_PatStatusOther>": 57576, | |
| "</s_8_PatStatusSingle>": 57774, | |
| "</s_8_PatStudentStatusCodeFT>": 57834, | |
| "</s_8_PatStudentStatusCodePT>": 57781, | |
| "</s_9A_SecInsPolGrpNumber>": 57769, | |
| "</s_9B_SecInsDOB>": 57612, | |
| "</s_9B_SecInsSexF>": 57794, | |
| "</s_9B_SecInsSexM>": 57593, | |
| "</s_9D_SecInsPlanName>": 57760, | |
| "</s_9_SecInsFullName>": 57704, | |
| "<one>": 57839, | |
| "<s_10A_PatConditionEmpN>": 57529, | |
| "<s_10A_PatConditionEmpY>": 57831, | |
| "<s_10B_PatAAState>": 57813, | |
| "<s_10B_PatConditionAutoN>": 57528, | |
| "<s_10B_PatConditionAutoY>": 57676, | |
| "<s_10C_PatConditionOtherN>": 57780, | |
| "<s_10C_PatConditionOtherY>": 57623, | |
| "<s_10D_ClaimCodes>": 57591, | |
| "<s_11A_PriInsDOB>": 57533, | |
| "<s_11A_PriInsSexF>": 57530, | |
| "<s_11A_PriInsSexM>": 57823, | |
| "<s_11B_OtherClaimIdCode>": 57661, | |
| "<s_11B_OtherClaimIdCodeQual>": 57747, | |
| "<s_11B_PriInsEmpName>": 57757, | |
| "<s_11C_PriInsPlanName>": 57686, | |
| "<s_11D_PriInsOtherPlanN>": 57799, | |
| "<s_11D_PriInsOtherPlanY>": 57617, | |
| "<s_11_PriInsPolGrpNumber>": 57749, | |
| "<s_12_PatSignonFile>": 57663, | |
| "<s_13_PriSignonFileList>": 57765, | |
| "<s_14_PatCurrentDate>": 57573, | |
| "<s_14_PatCurrentDateQual>": 57789, | |
| "<s_15_PatFirstDateOfIll>": 57817, | |
| "<s_15_PatFirstDateOfIllQual>": 57633, | |
| "<s_16_PatUTWFromDate>": 57635, | |
| "<s_16_PatUTWToDate>": 57669, | |
| "<s_17A_RefProvOtherId>": 57828, | |
| "<s_17A_RefProvOtherIdQual>": 57581, | |
| "<s_17B_RefProvNPI>": 57816, | |
| "<s_17_RefProvFullName>": 57736, | |
| "<s_17_RefProvFullNameQual>": 57737, | |
| "<s_17_RefProvOrgName>": 57764, | |
| "<s_18_PatHospFromDate>": 57621, | |
| "<s_18_PatHospToDate>": 57820, | |
| "<s_19_LocalUse>": 57836, | |
| "<s_19_LocalUsePrefix>": 57819, | |
| "<s_1A_PriInsIDNumber>": 57744, | |
| "<s_20_OSLabCharges>": 57587, | |
| "<s_20_OSLabN>": 57727, | |
| "<s_20_OSLabY>": 57708, | |
| "<s_21_DiagCode>": 57651, | |
| "<s_21_DiagDescription>": 57801, | |
| "<s_21_ICDInd>": 57698, | |
| "<s_22_MedicaidCode>": 57726, | |
| "<s_22_MedicaidRefNum>": 57619, | |
| "<s_23_PriorAuthNum>": 57574, | |
| "<s_24A_FromDate>": 57762, | |
| "<s_24A_ToDate>": 57531, | |
| "<s_24B_POS>": 57645, | |
| "<s_24C_EMG>": 57525, | |
| "<s_24D_Modifier>": 57832, | |
| "<s_24D_ProcCode>": 57664, | |
| "<s_24E_DiagPtr>": 57683, | |
| "<s_24F_LineCharges>": 57772, | |
| "<s_24G_Units>": 57721, | |
| "<s_24H_EPSDT>": 57785, | |
| "<s_24J_RenProvFullName>": 57716, | |
| "<s_24J_RenProvNPIId>": 57709, | |
| "<s_24J_RenProvOtherId>": 57731, | |
| "<s_24J_RenProvOtherIdQual>": 57628, | |
| "<s_24_AnesEndTime>": 57697, | |
| "<s_24_AnesMod>": 57729, | |
| "<s_24_AnesStartTime>": 57728, | |
| "<s_24_AnesTotalMin>": 57657, | |
| "<s_24_AnesTotalTime>": 57694, | |
| "<s_24_AnesUnits>": 57590, | |
| "<s_24_ClmDiscountAmount>": 57567, | |
| "<s_24_ClmNYSurChargeAmount>": 57606, | |
| "<s_24_ClmTaxAmount>": 57572, | |
| "<s_24_HCT>": 57654, | |
| "<s_24_MedicaidPaidAmount>": 57719, | |
| "<s_24_NDC>": 57672, | |
| "<s_24_NDCCharges>": 57646, | |
| "<s_24_NDCQualifier>": 57779, | |
| "<s_24_NDCUnits>": 57555, | |
| "<s_24_NDCUnitsQual>": 57718, | |
| "<s_24_ProcDesc>": 57541, | |
| "<s_25_BillProvEIN>": 57666, | |
| "<s_25_BillProvFedIdCode>": 57546, | |
| "<s_25_BillProvSSN>": 57653, | |
| "<s_26_PatAcctNo>": 57616, | |
| "<s_27_AcceptAssignmentN>": 57740, | |
| "<s_27_AcceptAssignmentY>": 57724, | |
| "<s_28_TotalCharges>": 57575, | |
| "<s_29_AmountPaid>": 57810, | |
| "<s_2_PatFullName>": 57809, | |
| "<s_30_BalanceDue>": 57804, | |
| "<s_31_PrnRenProvFullName>": 57579, | |
| "<s_31_RenDateSigned>": 57552, | |
| "<s_31_RenProvOrgName>": 57722, | |
| "<s_31_RenProvTaxonomyCode>": 57540, | |
| "<s_32_AmbToFacProvAddr1>": 57759, | |
| "<s_32_AmbToFacProvCity>": 57611, | |
| "<s_32_AmbToFacProvFullName>": 57648, | |
| "<s_32_AmbToFacProvNPIId>": 57659, | |
| "<s_32_AmbToFacProvOrgName>": 57776, | |
| "<s_32_AmbToFacProvOtherIdFull>": 57613, | |
| "<s_32_AmbToFacProvPostCode>": 57797, | |
| "<s_32_AmbToFacProvPostCodeExt>": 57723, | |
| "<s_32_AmbToFacProvState>": 57532, | |
| "<s_32_FacProvAddr1>": 57639, | |
| "<s_32_FacProvCity>": 57601, | |
| "<s_32_FacProvFullName>": 57569, | |
| "<s_32_FacProvNPIId>": 57733, | |
| "<s_32_FacProvOrgName>": 57751, | |
| "<s_32_FacProvOtherIdFull>": 57557, | |
| "<s_32_FacProvPostCode>": 57634, | |
| "<s_32_FacProvState>": 57730, | |
| "<s_32_MedicaidTaxId>": 57767, | |
| "<s_33_BillProvAddr1>": 57544, | |
| "<s_33_BillProvCity>": 57738, | |
| "<s_33_BillProvFullName>": 57811, | |
| "<s_33_BillProvNPIId>": 57771, | |
| "<s_33_BillProvOrgName>": 57665, | |
| "<s_33_BillProvOtherIdFull>": 57626, | |
| "<s_33_BillProvPhone>": 57739, | |
| "<s_33_BillProvPostCode>": 57586, | |
| "<s_33_BillProvState>": 57807, | |
| "<s_33_MediBillProvAddr1>": 57608, | |
| "<s_33_MediBillProvCity>": 57783, | |
| "<s_33_MediBillProvNPIId>": 57558, | |
| "<s_33_MediBillProvOrgName>": 57743, | |
| "<s_33_MediBillProvOtherIdFull>": 57829, | |
| "<s_33_MediBillProvPhone>": 57538, | |
| "<s_33_MediBillProvPostCode>": 57637, | |
| "<s_33_MediBillProvState>": 57566, | |
| "<s_33_MedicaidTaxId>": 57641, | |
| "<s_3_PatDOB>": 57624, | |
| "<s_3_PatSexF>": 57802, | |
| "<s_3_PatSexM>": 57615, | |
| "<s_4_PriInsFullName>": 57597, | |
| "<s_5_PatAddr1>": 57756, | |
| "<s_5_PatCity>": 57536, | |
| "<s_5_PatPhoneNumber>": 57766, | |
| "<s_5_PatPostCode>": 57539, | |
| "<s_5_PatState>": 57818, | |
| "<s_6_PatRelShipChild>": 57682, | |
| "<s_6_PatRelShipOther>": 57714, | |
| "<s_6_PatRelShipSelf>": 57599, | |
| "<s_6_PatRelShipSpouse>": 57826, | |
| "<s_7_PriInsAddr1>": 57578, | |
| "<s_7_PriInsCity>": 57677, | |
| "<s_7_PriInsPhoneNumber>": 57598, | |
| "<s_7_PriInsPostCode>": 57647, | |
| "<s_7_PriInsState>": 57696, | |
| "<s_8_PatEmpStatusCode>": 57588, | |
| "<s_8_PatStatusMarried>": 57815, | |
| "<s_8_PatStatusOther>": 57681, | |
| "<s_8_PatStatusSingle>": 57554, | |
| "<s_8_PatStudentStatusCodeFT>": 57690, | |
| "<s_8_PatStudentStatusCodePT>": 57790, | |
| "<s_9A_SecInsPolGrpNumber>": 57547, | |
| "<s_9B_SecInsDOB>": 57543, | |
| "<s_9B_SecInsSexF>": 57713, | |
| "<s_9B_SecInsSexM>": 57655, | |
| "<s_9D_SecInsPlanName>": 57746, | |
| "<s_9_SecInsFullName>": 57784, | |
| "<s_iitcdip>": 57523, | |
| "<s_synthdog>": 57524, | |
| "<sep/>": 57522, | |
| "[BLANK]": 57840 | |
| } | |