| { | |
| "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_5. PATIENT'S STATE>", | |
| "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_TRICARE CHAMPUS>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57583": { | |
| "content": "</s_words>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57584": { | |
| "content": "<s_13. INSURED OR AUTHORIZED PERSON'S SIGNATURE>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57585": { | |
| "content": "<s_11d. IS THERE ANOTHER HEALTH BENEFIT PLAN>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57586": { | |
| "content": "</s_5. PATIENT'S TELEPHONE>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57587": { | |
| "content": "</s_7. INSURED'S CITY>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57588": { | |
| "content": "<s_MM>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57589": { | |
| "content": "<s_DATE>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57590": { | |
| "content": "<s_5. PATIENT'S ZIP CODE>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57591": { | |
| "content": "<s_3. PATIENT'S DATE OF BIRTH>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57592": { | |
| "content": "<s_$CHARGES1>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57593": { | |
| "content": "</s_1a. INSURED'S I.D. NUMBER>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57594": { | |
| "content": "</s_11d. IS THERE ANOTHER HEALTH BENEFIT PLAN>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57595": { | |
| "content": "<s_DIAGNOSIS POINTER2>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57596": { | |
| "content": "<s_x>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57597": { | |
| "content": "<s_meta>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57598": { | |
| "content": "<s_PATIENT AND INSURED INFORMATION>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57599": { | |
| "content": "<s_7. INSURED'S STATE>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57600": { | |
| "content": "<s_DIAGNOSIS POINTER1>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57601": { | |
| "content": "<s_9a. OTHER INSURED'S POLICY>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57602": { | |
| "content": "<s_GROUP HEALTH PLAN>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57603": { | |
| "content": "<s_y>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57604": { | |
| "content": "<s_AUTO ACCIDENT>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57605": { | |
| "content": "<s_CPT/HCPCS2>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57606": { | |
| "content": "</s_7. INSURED'S ADDRESS>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57607": { | |
| "content": "</s_28. TOTAL CHARGE>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57608": { | |
| "content": "<s_2. PATIENT'S NAME>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57609": { | |
| "content": "<s_TRICARE CHAMPUS>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57610": { | |
| "content": "<s_MM2>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57611": { | |
| "content": "</s_20. OUTSIDE LAB>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57612": { | |
| "content": "</s_11a. INSURED'S SEX>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57613": { | |
| "content": "<s_23. PRIOR AUTHORIZATION NUMBER>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57614": { | |
| "content": "<s_4. INSURED'S NAME>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57615": { | |
| "content": "<s_PHYSICIAN OR MEDICAL PROVIDER INFORMATION>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57616": { | |
| "content": "</s_GROUP HEALTH PLAN>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57617": { | |
| "content": "</s_27. ACCEPT ASSIGNMENT>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57618": { | |
| "content": "</s_$CHARGES2>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57619": { | |
| "content": "</s_MM2>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57620": { | |
| "content": "<s_word>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57621": { | |
| "content": "<s_7. INSURED'S CITY>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57622": { | |
| "content": "<s_1a. INSURED'S I.D. NUMBER>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57623": { | |
| "content": "</s_MM1>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57624": { | |
| "content": "<s_11c. INSURANCE PLAN NAME>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57625": { | |
| "content": "<s_3. PATIENT'S SEX>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57626": { | |
| "content": "</s_DATE>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57627": { | |
| "content": "<s_21. DIAGNOSIS OR NATURE OF ILLNESS>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57628": { | |
| "content": "<s_MEDICAID>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57629": { | |
| "content": "</s_32. SERVICE FACILITY LOCATION>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57630": { | |
| "content": "<s_6. PATIENT RELATIONSHIP>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57631": { | |
| "content": "<s_$CHARGES2>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57632": { | |
| "content": "</s_YY1>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57633": { | |
| "content": "<s_normalizedVertices>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57634": { | |
| "content": "</s_3. PATIENT'S SEX>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57635": { | |
| "content": "</s_formnumber>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57636": { | |
| "content": "</s_13. INSURED OR AUTHORIZED PERSON'S SIGNATURE>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57637": { | |
| "content": "<s_UNITS2>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57638": { | |
| "content": "</s_PHYSICIAN OR MEDICAL PROVIDER INFORMATION>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57639": { | |
| "content": "<s_DD2>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57640": { | |
| "content": "</s_6. PATIENT RELATIONSHIP>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57641": { | |
| "content": "</s_4. INSURED'S NAME>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57642": { | |
| "content": "<s_MEDICARE>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57643": { | |
| "content": "</s_DD>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57644": { | |
| "content": "<s_FECA>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57645": { | |
| "content": "</s_CHAMPVA>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57646": { | |
| "content": "</s_3. PATIENT'S DATE OF BIRTH>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57647": { | |
| "content": "</s_x>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57648": { | |
| "content": "</s_y>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57649": { | |
| "content": "</s_24. SERVICES>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57650": { | |
| "content": "<s_10. PATIENT'S CONDITION>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57651": { | |
| "content": "<s_formtype>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57652": { | |
| "content": "<s_YY>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57653": { | |
| "content": "</s_DIAGNOSIS POINTER2>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57654": { | |
| "content": "</s_PATIENT AND INSURED INFORMATION>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57655": { | |
| "content": "<s_CHAMPVA>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57656": { | |
| "content": "<s_1.>", | |
| "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_9. OTHER INSURED'S NAME>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57659": { | |
| "content": "<s_UNITS1>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57660": { | |
| "content": "<s_7. INSURED'S ADDRESS>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57661": { | |
| "content": "<s_26. PATIENT'S ACCOUNT NUMBER>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57662": { | |
| "content": "<s_5. PATIENT'S ADDRESS>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57663": { | |
| "content": "</s_text>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57664": { | |
| "content": "</s_9a. OTHER INSURED'S POLICY>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57665": { | |
| "content": "<s_27. ACCEPT ASSIGNMENT>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57666": { | |
| "content": "</s_12. PATIENT'S OR AUTHORIZED PERSON'S SIGNATURE>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57667": { | |
| "content": "</s_5. PATIENT'S ZIP CODE>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57668": { | |
| "content": "<s_9d. INSURANCE PLAN NAME>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57669": { | |
| "content": "</s_26. PATIENT'S ACCOUNT NUMBER>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57670": { | |
| "content": "<s_YY2>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57671": { | |
| "content": "</s_AUTO ACCIDENT>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57672": { | |
| "content": "<s_SIGNED>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57673": { | |
| "content": "<s_5. PATIENT'S TELEPHONE>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57674": { | |
| "content": "</s_FECA>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57675": { | |
| "content": "</s_DD1>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57676": { | |
| "content": "</s_normalizedVertices>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57677": { | |
| "content": "<s_OTHER ACCIDENT>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57678": { | |
| "content": "<s_32. SERVICE FACILITY LOCATION>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57679": { | |
| "content": "</s_label>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57680": { | |
| "content": "</s_11. INSURED'S POLICY GROUP ORFECA NUMBER>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57681": { | |
| "content": "</s_EMPLOYMENT>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57682": { | |
| "content": "</s_formtype>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57683": { | |
| "content": "<s_EMPLOYMENT>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57684": { | |
| "content": "</s_UNITS2>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57685": { | |
| "content": "</s_CPT/HCPCS2>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57686": { | |
| "content": "</s_5. PATIENT'S STATE>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57687": { | |
| "content": "<s_OTHER>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57688": { | |
| "content": "</s_23. PRIOR AUTHORIZATION NUMBER>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57689": { | |
| "content": "</s_UNITS1>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57690": { | |
| "content": "</s_CPT/HCPCS1>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57691": { | |
| "content": "</s_MM>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57692": { | |
| "content": "<s_YY1>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57693": { | |
| "content": "</s_21. DIAGNOSIS OR NATURE OF ILLNESS>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57694": { | |
| "content": "<s_MM1>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57695": { | |
| "content": "<s_28. TOTAL CHARGE>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57696": { | |
| "content": "<s_DD>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57697": { | |
| "content": "</s_OTHER ACCIDENT>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57698": { | |
| "content": "</s_1.>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57699": { | |
| "content": "</s_YY2>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57700": { | |
| "content": "<s_label>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57701": { | |
| "content": "</s_2. PATIENT'S NAME>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57702": { | |
| "content": "</s_5. PATIENT'S ADDRESS>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57703": { | |
| "content": "<s_20. OUTSIDE LAB>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57704": { | |
| "content": "</s_7. INSURED'S STATE>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false, | |
| "special": true | |
| }, | |
| "57705": { | |
| "content": "<s_text>", | |
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