{
  "DatasetId": "c08da252-a46b-4c81-8dce-08dd8ee0ce18",
  "AccountNumber": 493696053,
  "ExternalAccountNumber": "10052",
  "Patient": {
    "FirstName": "zzVladSIE",
    "MiddleName": "",
    "LastName": "zzVladSIE",
    "Suffix": "",
    "SSN": "",
    "MedicalRecordNumber": "10553",
    "BirthDate": "1981-01-01T00:00:00",
    "Gender": "Female",
    "Address1": "12312312",
    "Address2": "",
    "City": "HANCOCK",
    "StateCode": "MA",
    "Zip": "01237",
    "CountryCode": "",
    "HomePhone": "",
    "WorkPhone": "",
    "MobilePhone": "(214) 312-0000",
    "Email": "",
    "UseAlternateMailingAddress": false,
    "AlternateName": "",
    "AlternateAddress1": "",
    "AlternateAddress2": "",
    "AlternateCity": "",
    "AlternateStateCode": "",
    "AlternateZip": "",
    "AlternateCountryCode": "",
    "EmployerName": "",
    "EmployerAddress1": "",
    "EmployerAddress2": "",
    "EmployerCity": "",
    "EmployerStateCode": "",
    "EmployerZip": "",
    "EmployerCountryCode": "",
    "EmployerPhone": ""
  },
  "Guarantor": {
    "FirstName": "zzVladSIE",
    "MiddleName": "",
    "LastName": "zzVladSIE",
    "Suffix": "",
    "SSN": "",
    "BirthDate": "1981-01-01T00:00:00",
    "Gender": "Female",
    "Address1": "12312312",
    "Address2": "",
    "City": "HANCOCK",
    "StateCode": "MA",
    "Zip": "01237",
    "CountryCode": "",
    "HomePhone": "",
    "WorkPhone": "",
    "MobilePhone": "(214) 312-0000",
    "Email": "",
    "UseAlternateMailingAddress": false,
    "AlternateName": "",
    "AlternateAddress1": "",
    "AlternateAddress2": "",
    "AlternateCity": "",
    "AlternateStateCode": "",
    "AlternateZip": "",
    "AlternateCountryCode": "",
    "EmployerName": "",
    "EmployerAddress1": "",
    "EmployerAddress2": "",
    "EmployerCity": "",
    "EmployerStateCode": "",
    "EmployerZip": "",
    "EmployerCountryCode": "",
    "EmployerPhone": "",
    "EmployerCode": "",
    "EmergencyContactFirstName": "",
    "EmergencyContactLastName": "",
    "EmergencyContactRelation": "",
    "EmergencyContactPhone": "",
    "DriverLicenseNumber": "",
    "SameAsPatient": false
  },
  "Insurances": [
    {
      "InsuranceLevel": "Primary",
      "InsuranceType": "",
      "PolicyNumber": "POL_NUM",
      "GroupNumber": "",
      "PlanName": "",
      "InsuredRelation": "Self",
      "InsuredLastName": "zzVladSIE",
      "InsuredFirstName": "zzVladSIE",
      "InsuredMiddleName": "",
      "InsuredSuffix": "",
      "InsuredBirthDate": "1981-01-01T00:00:00",
      "InsuredGender": "Female",
      "UseGuarantorContactInfo": false,
      "InsuredAddress1": "12312312",
      "InsuredAddress2": "",
      "InsuredCity": "HANCOCK",
      "InsuredStateCode": "MA",
      "InsuredZip": "01237",
      "InsuredCountryCode": "",
      "InsuredPhone": "",
      "PolicyEffectiveFrom": "2025-10-03T00:00:00",
      "PolicyEffectiveTo": null,
      "AcceptAssignment": true,
      "CarrierCode": "1",
      "CarrierName": "Sunflower",
      "CarrierAddress1": "123 W 43rd St S",
      "CarrierAddress2": "",
      "CarrierCity": "WICHITA",
      "CarrierStateCode": "KS",
      "CarrierZip": "67212",
      "CarrierCountryCode": "",
      "CarrierPhoneNumber": "",
      "CarrierType": "Commercial",
      "PayerId": "",
      "ExternalId": "10052_76",
      "Id": "4e0641c5-b076-43e0-7534-08de024f4554"
    }
  ],
  "Visits": [
    {
      "ExternalId": "10052",
      "ReferenceNumber": 1,
      "AccidentType": null,
      "AccidentStateCode": null,
      "FinancialClass": null,
      "HospitalAdmitDate": null,
      "HospitalDischargeDate": null,
      "IllnessInjuryDate": null,
      "PrimaryInsuranceAuthNumber": null,
      "SecondaryInsuranceAuthNumber": null,
      "TertiaryInsuranceAuthNumber": null,
      "PrimaryInsuranceCarrier": "1",
      "SecondaryInsuranceCarrier": null,
      "TertiaryInsuranceCarrier": null,
      "PrimaryInsuranceId": "4e0641c5-b076-43e0-7534-08de024f4554",
      "SecondaryInsuranceId": null,
      "TertiaryInsuranceId": null,
      "EstimatedPatientBalance": 0.0,
      "InstitutionalFields": null,
      "Procedures": [
        {
          "AccessionNumber": "10068",
          "ProcedureCode": "71130",
          "AttendingProvider": "medq",
          "ReferringProvider": "zzRPHY",
          "OrderingProvider": "zzRPHY",
          "PrimaryProvider": null,
          "SupervisingProvider": null,
          "FromDate": "2025-10-03T00:00:00",
          "ToDate": "2025-10-03T00:00:00",
          "PlaceOfServiceCode": "49",
          "Location": "SIE",
          "Modifier1": null,
          "Modifier2": null,
          "Modifier3": null,
          "Modifier4": null,
          "Quantity": "1",
          "InsuranceAuthNumber": null,
          "NOCProcedureDescription": "X-ray strenoclavic jt 3/>vws",
          "PrescriptionNumber": null,
          "HoldPatientBilling": null,
          "HoldInsuranceBilling": false,
          "ChargeGroup": null,
          "ClaimComment": null,
          "Diagnosis1": "A00.0",
          "Diagnosis2": null,
          "Diagnosis3": null,
          "Diagnosis4": null,
          "Diagnosis5": null,
          "Diagnosis6": null,
          "Diagnosis7": null,
          "Diagnosis8": null,
          "Diagnosis9": null,
          "Diagnosis10": null,
          "Diagnosis11": null,
          "Diagnosis12": null,
          "ExternalId": "10068"
        }
      ]
    }
  ],
  "DatesOfService": [
    {
      "FromDate": "2025-10-03T00:00:00",
      "ToDate": "2025-10-03T00:00:00"
    }
  ],
  "PatientBalance": 0.0,
  "InsuranceBalance": 2.0
}