| { | |
| "additional_special_tokens": [ | |
| { | |
| "content": "<s>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_3_State>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_21_DOB>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_13_DOB>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_18_Other>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_58_Fac_ProvIDFull>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_20_Zip>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_6_DOB>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_3_Address>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_48_Suffix>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_43_No>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_7_F>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_18_Child>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_54_NPI>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_17_Name>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_29B_Units>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_10_Other>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_10_Spouse>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_29_Proc_Code>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_7_M>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_48_Address>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_20_State>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_16_Grp_Num>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_56_State>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_18_Child>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_19_Code_FT>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_43_Yes>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_36_Sign_Date>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_54_NPI>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_31_Fee>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_51_SSN_TIN>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_56_A_Code>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_30_Description>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_56_Zip>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_49_NPI>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_56_Address>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_12_State>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_41_Date>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_18_Self>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_12_City>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_47_Auto>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_40_Yes>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_3_Company>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_12_Address>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_1_TypeEPSDT>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_48_State>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_10_Dependent>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_20_State>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_45_Other_accident>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_3_Ph_Number>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_1_Type>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_25_Oral_Cavity>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_10_Spouse>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_58_Fac_ProvIDFull>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_48_Name>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_25_Tooth_sys>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_40_Yes>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_11_Zip>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_42_Months_remain>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_35_Remarks>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_36_Signature >", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_53_Sign>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_22_M>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_3_Zip>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_52_Ph_Number>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_11_City>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_19_Code_FT>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_11_Ph_Number>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_20_Address>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_56_Zip>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_56_A_Code>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_21_DOB>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_11_State>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_48_State>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_45_Auto_accident>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_20_Zip>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_14_M>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_35_NEA>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_12_State>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_20_Name>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_10_Dependent>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_3_Ph_Number>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_13_DOB>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_53_Sign_Date>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_23_Patient_ID>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_56_City>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_37_Signature>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_33_Total_Fee>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_48_Org_Name>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_5_Name>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_18_Spouse>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_19_Code_PT>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_1_Type>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_34_ICDInd>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_20_Address>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_14_F>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_50_License>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_40_No>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_37_Sign_Date>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_7_M>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_12_Name>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_19_Code_PT>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_14_M>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_48_Name>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_57_Ph_Number>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_22_F>", | |
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| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_3_Address>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_24_Proc_Date>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_12_City>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_44_Date>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_8_SSN_ID>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "</s_5_Name>", | |
| "lstrip": false, | |
| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_37_Sign_Date>", | |
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| "normalized": false, | |
| "rstrip": false, | |
| "single_word": false | |
| }, | |
| { | |
| "content": "<s_11_City>", | |
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| }, | |
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| }, | |
| { | |
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| }, | |
| { | |
| "content": "</s_4_Dental_Medical>", | |
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| }, | |
| { | |
| "content": "<s_48_Zip>", | |
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| }, | |
| { | |
| "content": "</s_18_Other>", | |
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| }, | |
| { | |
| "content": "</s_33_Missing_Teeth>", | |
| "lstrip": false, | |
| "normalized": false, | |
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| "single_word": false | |
| }, | |
| { | |
| "content": "</s_45_Other_accident>", | |
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| "single_word": false | |
| }, | |
| { | |
| "content": "</s_34_D_Code>", | |
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| }, | |
| { | |
| "content": "<s_44_Date>", | |
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| "normalized": false, | |
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| "single_word": false | |
| }, | |
| { | |
| "content": "</s_3_City>", | |
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| } | |
| ], | |
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| "content": "</s>", | |
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