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"single_word": false |
|
}, |
|
{ |
|
"content": "<s_EMG 3>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_EMG 3>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_DIAGNOSIS POINTER 3>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_DIAGNOSIS POINTER 3>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_DD 3>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_DD 3>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_CPT/HCPCS 3>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_CPT/HCPCS 3>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_$CHARGES 3>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_$CHARGES 3>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_23. PRIOR AUTHORIZATION NUMBER>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_23. PRIOR AUTHORIZATION NUMBER>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_22. RESUBMISSION CODE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_22. RESUBMISSION CODE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_21. DIAGNOSIS OR NATURE OF ILLNESS>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_21. DIAGNOSIS OR NATURE OF ILLNESS>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_words>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_words>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_word>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_word>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_normalizedVertices>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_normalizedVertices>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_y>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_y>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_x>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_x>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_text>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_text>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_label>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_label>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_ILLNESS D.>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_ILLNESS D.>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_ILLNESS C.>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_ILLNESS C.>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_ILLNESS B.>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_ILLNESS B.>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_ILLNESS A.>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_ILLNESS A.>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_ILLNESS F.>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_ILLNESS F.>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_ILLNESS E.>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_ILLNESS E.>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_20. OUTSIDE LAB>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_20. OUTSIDE LAB>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_20. LAB $CHARGES>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_20. LAB $CHARGES>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_PATIENT AND INSURED INFORMATION>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_PATIENT AND INSURED INFORMATION>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_9d. INSURANCE PLAN NAME>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_9d. INSURANCE PLAN NAME>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_9a. OTHER INSURED'S POLICY OR GROUP>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_9a. OTHER INSURED'S POLICY OR GROUP>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_9. OTHER INSURED'S NAME>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_9. OTHER INSURED'S NAME>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_7. INSURED'S INFO>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_7. INSURED'S INFO>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_4. INSURED'S NAME>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_4. INSURED'S NAME>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_7. INSURED'S ADDRESS>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_7. INSURED'S ADDRESS>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_7. INSURED'S STATE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_7. INSURED'S STATE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_7. INSURED'S CITY>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_7. INSURED'S CITY>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_7. INSURED'S ZIP CODE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_7. INSURED'S ZIP CODE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_7. INSURED'S TELEPHONE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_7. INSURED'S TELEPHONE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_6. PATIENT RELATIONSHIP>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_6. PATIENT RELATIONSHIP>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_5. PATIENT'S ZIP CODE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_5. PATIENT'S ZIP CODE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_5. PATIENT'S TELEPHONE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_5. PATIENT'S TELEPHONE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_5. PATIENT'S STATE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_5. PATIENT'S STATE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_5. PATIENT'S CITY>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_5. PATIENT'S CITY>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_5. PATIENT'S ADDRESS>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_5. PATIENT'S ADDRESS>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_3. PATIENT'S SEX>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_3. PATIENT'S SEX>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_3. PATIENT'S DATE OF BIRTH>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_3. PATIENT'S DATE OF BIRTH>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_YY>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_YY>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_MM>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_MM>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_DD>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_DD>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_2. PATIENT'S NAME>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_2. PATIENT'S NAME>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_1a. INSURED'S I.D. NUMBER>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_1a. INSURED'S I.D. NUMBER>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_13. INSURED OR AUTHORIZED PERSON'S SIGNATURE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_13. INSURED OR AUTHORIZED PERSON'S SIGNATURE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_12. PATIENT'S OR AUTHORIZED PERSON'S SIGNATURE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_12. PATIENT'S OR AUTHORIZED PERSON'S SIGNATURE>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "<s_11d. IS THERE ANOTHER HEALTH BENEFIT PLAN>", |
|
"lstrip": false, |
|
"normalized": false, |
|
"rstrip": false, |
|
"single_word": false |
|
}, |
|
{ |
|
"content": "</s_11d. IS THERE ANOTHER HEALTH BENEFIT PLAN>", |
|
"lstrip": false, |
|
"normalized": false, |
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