|
{ |
|
"added_tokens_decoder": { |
|
"0": { |
|
"content": "<s>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"1": { |
|
"content": "<pad>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"2": { |
|
"content": "</s>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"3": { |
|
"content": "<unk>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57521": { |
|
"content": "<mask>", |
|
"lstrip": true, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57522": { |
|
"content": "<sep/>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57523": { |
|
"content": "<s_iitcdip>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57524": { |
|
"content": "<s_synthdog>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57525": { |
|
"content": "</s_menu>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57526": { |
|
"content": "<s_menu>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57527": { |
|
"content": "</s_nm>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57528": { |
|
"content": "<s_nm>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57529": { |
|
"content": "</s_cnt>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57530": { |
|
"content": "<s_cnt>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57531": { |
|
"content": "</s_price>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57532": { |
|
"content": "<s_price>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57533": { |
|
"content": "</s_sub_total>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57534": { |
|
"content": "<s_sub_total>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57535": { |
|
"content": "</s_subtotal_price>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57536": { |
|
"content": "<s_subtotal_price>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57537": { |
|
"content": "</s_service_price>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57538": { |
|
"content": "<s_service_price>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57539": { |
|
"content": "</s_tax_price>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57540": { |
|
"content": "<s_tax_price>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57541": { |
|
"content": "</s_etc>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57542": { |
|
"content": "<s_etc>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57543": { |
|
"content": "</s_total>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57544": { |
|
"content": "<s_total>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57545": { |
|
"content": "</s_total_price>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57546": { |
|
"content": "<s_total_price>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57547": { |
|
"content": "</s_sub>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57548": { |
|
"content": "<s_sub>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57549": { |
|
"content": "</s_cashprice>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57550": { |
|
"content": "<s_cashprice>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57551": { |
|
"content": "</s_changeprice>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57552": { |
|
"content": "<s_changeprice>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57553": { |
|
"content": "</s_menutype_cnt>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57554": { |
|
"content": "<s_menutype_cnt>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57555": { |
|
"content": "</s_menuqty_cnt>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57556": { |
|
"content": "<s_menuqty_cnt>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57557": { |
|
"content": "</s_discount_price>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57558": { |
|
"content": "<s_discount_price>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57559": { |
|
"content": "</s_unitprice>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57560": { |
|
"content": "<s_unitprice>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57561": { |
|
"content": "</s_total_etc>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57562": { |
|
"content": "<s_total_etc>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57563": { |
|
"content": "</s_creditcardprice>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57564": { |
|
"content": "<s_creditcardprice>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57565": { |
|
"content": "</s_num>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57566": { |
|
"content": "<s_num>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57567": { |
|
"content": "</s_discountprice>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57568": { |
|
"content": "<s_discountprice>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57569": { |
|
"content": "</s_emoneyprice>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57570": { |
|
"content": "<s_emoneyprice>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57571": { |
|
"content": "</s_void_menu>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57572": { |
|
"content": "<s_void_menu>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57573": { |
|
"content": "</s_othersvc_price>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57574": { |
|
"content": "<s_othersvc_price>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57575": { |
|
"content": "</s_vatyn>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57576": { |
|
"content": "<s_vatyn>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57577": { |
|
"content": "</s_itemsubtotal>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57578": { |
|
"content": "<s_itemsubtotal>", |
|
"lstrip": false, |
|
"normalized": true, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": false |
|
}, |
|
"57579": { |
|
"content": "<s_cord-v2>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57580": { |
|
"content": "</s_TRICARE CHAMPUS>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57581": { |
|
"content": "</s_YY>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57582": { |
|
"content": "<s_13. INSURED OR AUTHORIZED PERSON'S SIGNATURE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57583": { |
|
"content": "</s_d. IS THERE ANOTHER HEALTH BENEFIT PLAN>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57584": { |
|
"content": "</s_$ CHARGES1>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57585": { |
|
"content": "<s_MM>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57586": { |
|
"content": "<s_DATE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57587": { |
|
"content": "</s_1a. INSURED'S I.D. NUMBER>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57588": { |
|
"content": "<s_meta>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57589": { |
|
"content": "<s_GROUP HEALTH PLAN>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57590": { |
|
"content": "<s_10. PATIENT CONDITION>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57591": { |
|
"content": "<s_AUTO ACCIDENT>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57592": { |
|
"content": "<s_CPT/HCPCS2>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57593": { |
|
"content": "</s_ZIP CODE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57594": { |
|
"content": "</s_7. INSURED'S ADDRESS>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57595": { |
|
"content": "</s_28. TOTAL CHARGE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57596": { |
|
"content": "<s_TRICARE CHAMPUS>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57597": { |
|
"content": "<s_2. PATIENT'S NAME>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57598": { |
|
"content": "<s_23. PRIOR AUTHORIZATION NUMBER>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57599": { |
|
"content": "<s_4. INSURED'S NAME>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57600": { |
|
"content": "<s_E. DIAGNOSIS>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57601": { |
|
"content": "</s_GROUP HEALTH PLAN>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57602": { |
|
"content": "<s_STATE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57603": { |
|
"content": "</s_27. ACCEPT ASSIGNMENT>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57604": { |
|
"content": "</s_3. PATIENT's BIRTH DATE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57605": { |
|
"content": "<s_1a. INSURED'S I.D. NUMBER>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57606": { |
|
"content": "</s_CITY>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57607": { |
|
"content": "</s_MM1>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57608": { |
|
"content": "<s_F.>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57609": { |
|
"content": "</s_DATE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57610": { |
|
"content": "<s_21. DIAGNOSIS OR NATURE OF ILLNESS>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57611": { |
|
"content": "<s_MEDICAID>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57612": { |
|
"content": "</s_32. SERVICE FACILITY LOCATION>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57613": { |
|
"content": "<s_6. PATIENT RELATIONSHIP>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57614": { |
|
"content": "</s_YY1>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57615": { |
|
"content": "</s_formnumber>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57616": { |
|
"content": "<s_1. MEDICARE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57617": { |
|
"content": "<s_24. DATE OF SERVICE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57618": { |
|
"content": "</s_13. INSURED OR AUTHORIZED PERSON'S SIGNATURE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57619": { |
|
"content": "</s_DAYS OR UNITS>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57620": { |
|
"content": "</s_6. PATIENT RELATIONSHIP>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57621": { |
|
"content": "</s_8. PATIENT STATUS>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57622": { |
|
"content": "</s_4. INSURED'S NAME>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57623": { |
|
"content": "<s_MEDICAL PROVIDER INFORMATION>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57624": { |
|
"content": "</s_DD>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57625": { |
|
"content": "<s_FECA>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57626": { |
|
"content": "</s_CHAMPVA>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57627": { |
|
"content": "</s_STATE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57628": { |
|
"content": "</s_SEX>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57629": { |
|
"content": "<s_d. INSURANCE PLAN NAME>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57630": { |
|
"content": "<s_formtype>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57631": { |
|
"content": "<s_YY>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57632": { |
|
"content": "<s_CHAMPVA>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57633": { |
|
"content": "</s_10. PATIENT CONDITION>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57634": { |
|
"content": "<s_1.>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57635": { |
|
"content": "<s_DD1>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57636": { |
|
"content": "</s_9. OTHER INSURED'S NAME>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57637": { |
|
"content": "<s_7. INSURED'S ADDRESS>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57638": { |
|
"content": "<s_26. PATIENT'S ACCOUNT NUMBER>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57639": { |
|
"content": "<s_5. PATIENT'S ADDRESS>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57640": { |
|
"content": "<s_G.>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57641": { |
|
"content": "<s_2.>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57642": { |
|
"content": "</s_12. PATIENT'S OR AUTHORIZED PERSON'S SIGNATURE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57643": { |
|
"content": "</s_D. PROCEDURES, SERVICES>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57644": { |
|
"content": "<s_27. ACCEPT ASSIGNMENT>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57645": { |
|
"content": "</s_$ CHARGES2>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57646": { |
|
"content": "</s_26. PATIENT'S ACCOUNT NUMBER>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57647": { |
|
"content": "</s_AUTO ACCIDENT>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57648": { |
|
"content": "</s_24. DATE OF SERVICE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57649": { |
|
"content": "<s_3. PATIENT's BIRTH DATE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57650": { |
|
"content": "</s_1. MEDICARE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57651": { |
|
"content": "</s_POINTER1>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57652": { |
|
"content": "<s_$ CHARGES1>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57653": { |
|
"content": "<s_ZIP CODE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57654": { |
|
"content": "</s_FECA>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57655": { |
|
"content": "<s_$ CHARGES2>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57656": { |
|
"content": "<s_OTHER ACCIDENT>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57657": { |
|
"content": "</s_DD1>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57658": { |
|
"content": "<s_32. SERVICE FACILITY LOCATION>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57659": { |
|
"content": "</s_11. INSURED'S POLICY GROUP ORFECA NUMBER>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57660": { |
|
"content": "</s_EMPLOYMENT>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57661": { |
|
"content": "</s_formtype>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57662": { |
|
"content": "<s_EMPLOYMENT>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57663": { |
|
"content": "</s_CPT/HCPCS2>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57664": { |
|
"content": "<s_OTHER>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57665": { |
|
"content": "</s_23. PRIOR AUTHORIZATION NUMBER>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57666": { |
|
"content": "</s_CPT/HCPCS1>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57667": { |
|
"content": "</s_MM>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57668": { |
|
"content": "<s_DAYS OR UNITS>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57669": { |
|
"content": "<s_YY1>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57670": { |
|
"content": "<s_MM1>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57671": { |
|
"content": "<s_28. TOTAL CHARGE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57672": { |
|
"content": "</s_21. DIAGNOSIS OR NATURE OF ILLNESS>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57673": { |
|
"content": "<s_DD>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
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}, |
|
"57674": { |
|
"content": "</s_OTHER ACCIDENT>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57675": { |
|
"content": "</s_1.>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57676": { |
|
"content": "</s_MEMBER AND PATIENT INFORMATION>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
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}, |
|
"57677": { |
|
"content": "</s_2. PATIENT'S NAME>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57678": { |
|
"content": "</s_5. PATIENT'S ADDRESS>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57679": { |
|
"content": "</s_G.>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57680": { |
|
"content": "<s_SEX>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57681": { |
|
"content": "</s_OTHER>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57682": { |
|
"content": "<s_8. PATIENT STATUS>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57683": { |
|
"content": "<s_11. INSURED'S POLICY GROUP ORFECA NUMBER>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57684": { |
|
"content": "<s_d. IS THERE ANOTHER HEALTH BENEFIT PLAN>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57685": { |
|
"content": "</s_meta>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57686": { |
|
"content": "</s_E. DIAGNOSIS>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57687": { |
|
"content": "<s_POINTER1>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57688": { |
|
"content": "<s_CPT/HCPCS1>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
}, |
|
"57689": { |
|
"content": "</s_MEDICAL PROVIDER INFORMATION>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false, |
|
"special": true |
|
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