ShekDass's picture
End of training
8947d7d verified
{
"</s_$CHARGES1>": 57719,
"</s_$CHARGES2>": 57618,
"</s_1.>": 57698,
"</s_10. PATIENT'S CONDITION>": 57706,
"</s_11. INSURED'S POLICY GROUP ORFECA NUMBER>": 57680,
"</s_11a. INSURED'S SEX>": 57612,
"</s_11c. INSURANCE PLAN NAME>": 57718,
"</s_11d. IS THERE ANOTHER HEALTH BENEFIT PLAN>": 57594,
"</s_12. PATIENT'S OR AUTHORIZED PERSON'S SIGNATURE>": 57666,
"</s_13. INSURED OR AUTHORIZED PERSON'S SIGNATURE>": 57636,
"</s_1a. INSURED'S I.D. NUMBER>": 57593,
"</s_2. PATIENT'S NAME>": 57701,
"</s_20. OUTSIDE LAB>": 57611,
"</s_21. DIAGNOSIS OR NATURE OF ILLNESS>": 57693,
"</s_23. PRIOR AUTHORIZATION NUMBER>": 57688,
"</s_24. SERVICES>": 57649,
"</s_26. PATIENT'S ACCOUNT NUMBER>": 57669,
"</s_27. ACCEPT ASSIGNMENT>": 57617,
"</s_28. TOTAL CHARGE>": 57607,
"</s_29. AMOUNT PAID>": 57729,
"</s_3. PATIENT'S DATE OF BIRTH>": 57646,
"</s_3. PATIENT'S SEX>": 57634,
"</s_32. SERVICE FACILITY LOCATION>": 57629,
"</s_4. INSURED'S NAME>": 57641,
"</s_5. PATIENT'S ADDRESS>": 57702,
"</s_5. PATIENT'S CITY>": 57714,
"</s_5. PATIENT'S STATE>": 57686,
"</s_5. PATIENT'S TELEPHONE>": 57586,
"</s_5. PATIENT'S ZIP CODE>": 57667,
"</s_6. PATIENT RELATIONSHIP>": 57640,
"</s_7. INSURED'S ADDRESS>": 57606,
"</s_7. INSURED'S CITY>": 57587,
"</s_7. INSURED'S STATE>": 57704,
"</s_9. OTHER INSURED'S NAME>": 57658,
"</s_9a. OTHER INSURED'S POLICY>": 57664,
"</s_9d. INSURANCE PLAN NAME>": 57712,
"</s_AUTO ACCIDENT>": 57671,
"</s_CHAMPVA>": 57645,
"</s_CPT/HCPCS1>": 57690,
"</s_CPT/HCPCS2>": 57685,
"</s_DATE>": 57626,
"</s_DD1>": 57675,
"</s_DD2>": 57711,
"</s_DD>": 57643,
"</s_DIAGNOSIS POINTER1>": 57708,
"</s_DIAGNOSIS POINTER2>": 57653,
"</s_EMPLOYMENT>": 57681,
"</s_FECA>": 57674,
"</s_GROUP HEALTH PLAN>": 57616,
"</s_MEDICAID>": 57725,
"</s_MEDICARE>": 57727,
"</s_MM1>": 57623,
"</s_MM2>": 57619,
"</s_MM>": 57691,
"</s_OTHER ACCIDENT>": 57697,
"</s_OTHER>": 57707,
"</s_PATIENT AND INSURED INFORMATION>": 57654,
"</s_PHYSICIAN OR MEDICAL PROVIDER INFORMATION>": 57638,
"</s_SIGNED>": 57721,
"</s_TRICARE CHAMPUS>": 57582,
"</s_UNITS1>": 57689,
"</s_UNITS2>": 57684,
"</s_YY1>": 57632,
"</s_YY2>": 57699,
"</s_YY>": 57581,
"</s_cashprice>": 57549,
"</s_changeprice>": 57551,
"</s_cnt>": 57529,
"</s_creditcardprice>": 57563,
"</s_discount_price>": 57557,
"</s_discountprice>": 57567,
"</s_emoneyprice>": 57569,
"</s_etc>": 57541,
"</s_formnumber>": 57635,
"</s_formtype>": 57682,
"</s_itemsubtotal>": 57577,
"</s_label>": 57679,
"</s_menu>": 57525,
"</s_menuqty_cnt>": 57555,
"</s_menutype_cnt>": 57553,
"</s_meta>": 57713,
"</s_nm>": 57527,
"</s_normalizedVertices>": 57676,
"</s_num>": 57565,
"</s_othersvc_price>": 57573,
"</s_price>": 57531,
"</s_service_price>": 57537,
"</s_sub>": 57547,
"</s_sub_total>": 57533,
"</s_subtotal_price>": 57535,
"</s_tax_price>": 57539,
"</s_text>": 57663,
"</s_total>": 57543,
"</s_total_etc>": 57561,
"</s_total_price>": 57545,
"</s_unitprice>": 57559,
"</s_vatyn>": 57575,
"</s_void_menu>": 57571,
"</s_word>": 57724,
"</s_words>": 57583,
"</s_x>": 57647,
"</s_y>": 57648,
"<s_$CHARGES1>": 57592,
"<s_$CHARGES2>": 57631,
"<s_1.>": 57656,
"<s_10. PATIENT'S CONDITION>": 57650,
"<s_11. INSURED'S POLICY GROUP ORFECA NUMBER>": 57710,
"<s_11a. INSURED'S SEX>": 57709,
"<s_11c. INSURANCE PLAN NAME>": 57624,
"<s_11d. IS THERE ANOTHER HEALTH BENEFIT PLAN>": 57585,
"<s_12. PATIENT'S OR AUTHORIZED PERSON'S SIGNATURE>": 57726,
"<s_13. INSURED OR AUTHORIZED PERSON'S SIGNATURE>": 57584,
"<s_1a. INSURED'S I.D. NUMBER>": 57622,
"<s_2. PATIENT'S NAME>": 57608,
"<s_20. OUTSIDE LAB>": 57703,
"<s_21. DIAGNOSIS OR NATURE OF ILLNESS>": 57627,
"<s_23. PRIOR AUTHORIZATION NUMBER>": 57613,
"<s_24. SERVICES>": 57716,
"<s_26. PATIENT'S ACCOUNT NUMBER>": 57661,
"<s_27. ACCEPT ASSIGNMENT>": 57665,
"<s_28. TOTAL CHARGE>": 57695,
"<s_29. AMOUNT PAID>": 57722,
"<s_3. PATIENT'S DATE OF BIRTH>": 57591,
"<s_3. PATIENT'S SEX>": 57625,
"<s_32. SERVICE FACILITY LOCATION>": 57678,
"<s_4. INSURED'S NAME>": 57614,
"<s_5. PATIENT'S ADDRESS>": 57662,
"<s_5. PATIENT'S CITY>": 57717,
"<s_5. PATIENT'S STATE>": 57580,
"<s_5. PATIENT'S TELEPHONE>": 57673,
"<s_5. PATIENT'S ZIP CODE>": 57590,
"<s_6. PATIENT RELATIONSHIP>": 57630,
"<s_7. INSURED'S ADDRESS>": 57660,
"<s_7. INSURED'S CITY>": 57621,
"<s_7. INSURED'S STATE>": 57599,
"<s_9. OTHER INSURED'S NAME>": 57723,
"<s_9a. OTHER INSURED'S POLICY>": 57601,
"<s_9d. INSURANCE PLAN NAME>": 57668,
"<s_AUTO ACCIDENT>": 57604,
"<s_CHAMPVA>": 57655,
"<s_CPT/HCPCS1>": 57715,
"<s_CPT/HCPCS2>": 57605,
"<s_DATE>": 57589,
"<s_DD1>": 57657,
"<s_DD2>": 57639,
"<s_DD>": 57696,
"<s_DIAGNOSIS POINTER1>": 57600,
"<s_DIAGNOSIS POINTER2>": 57595,
"<s_EMPLOYMENT>": 57683,
"<s_FECA>": 57644,
"<s_GROUP HEALTH PLAN>": 57602,
"<s_MEDICAID>": 57628,
"<s_MEDICARE>": 57642,
"<s_MM1>": 57694,
"<s_MM2>": 57610,
"<s_MM>": 57588,
"<s_OTHER ACCIDENT>": 57677,
"<s_OTHER>": 57687,
"<s_PATIENT AND INSURED INFORMATION>": 57598,
"<s_PHYSICIAN OR MEDICAL PROVIDER INFORMATION>": 57615,
"<s_SIGNED>": 57672,
"<s_TRICARE CHAMPUS>": 57609,
"<s_UNITS1>": 57659,
"<s_UNITS2>": 57637,
"<s_YY1>": 57692,
"<s_YY2>": 57670,
"<s_YY>": 57652,
"<s_cashprice>": 57550,
"<s_changeprice>": 57552,
"<s_cnt>": 57530,
"<s_cord-v2>": 57579,
"<s_creditcardprice>": 57564,
"<s_discount_price>": 57558,
"<s_discountprice>": 57568,
"<s_emoneyprice>": 57570,
"<s_etc>": 57542,
"<s_formnumber>": 57728,
"<s_formtype>": 57651,
"<s_iitcdip>": 57523,
"<s_itemsubtotal>": 57578,
"<s_label>": 57700,
"<s_menu>": 57526,
"<s_menuqty_cnt>": 57556,
"<s_menutype_cnt>": 57554,
"<s_meta>": 57597,
"<s_nm>": 57528,
"<s_normalizedVertices>": 57633,
"<s_num>": 57566,
"<s_othersvc_price>": 57574,
"<s_price>": 57532,
"<s_service_price>": 57538,
"<s_sub>": 57548,
"<s_sub_total>": 57534,
"<s_subtotal_price>": 57536,
"<s_synthdog>": 57524,
"<s_tax_price>": 57540,
"<s_text>": 57705,
"<s_total>": 57544,
"<s_total_etc>": 57562,
"<s_total_price>": 57546,
"<s_unitprice>": 57560,
"<s_vatyn>": 57576,
"<s_void_menu>": 57572,
"<s_word>": 57620,
"<s_words>": 57720,
"<s_x>": 57596,
"<s_y>": 57603,
"<sep/>": 57522
}