cms.json

{ type: 'cms', version: '2.0' }
{
    "data": {
        "demographics": {
            "name": {
                "first": "JOHN",
                "last": "DOE"
            },
            "dob": {
                "point": {
                    "date": "1910-01-01T00:00:00.000Z",
                    "precision": "day"
                }
            },
            "email": [
                {
                    "address": "JOHNDOE@example.com",
                    "type": ""
                }
            ],
            "phone": [
                {
                    "number": "123-456-7890",
                    "type": "primary home"
                }
            ],
            "addresses": [
                {
                    "use": "primary home",
                    "street_lines": [
                        "123 ANY ROAD"
                    ],
                    "city": "ANYTOWN",
                    "state": "VA",
                    "zip": "00001",
                    "country": "United States"
                }
            ]
        },
        "vitals": [
            {
                "vital": {
                    "code": "8480-6",
                    "name": "Intravascular Systolic",
                    "code_system_name": "LOINC"
                },
                "date_time": {
                    "point": {
                        "date": "2011-07-22T15:00:00.000Z",
                        "precision": "hour"
                    }
                },
                "value": 120,
                "unit": "mm[Hg]",
                "status": "completed"
            },
            {
                "vital": {
                    "code": "8462-4",
                    "name": "Intravascular Diastolic",
                    "code_system_name": "LOINC"
                },
                "date_time": {
                    "point": {
                        "date": "2011-07-22T15:00:00.000Z",
                        "precision": "hour"
                    }
                },
                "value": 80,
                "unit": "mm[Hg]",
                "status": "completed"
            },
            {
                "vital": {
                    "name": "Glucose"
                },
                "date_time": {
                    "point": {
                        "date": "2012-03-20T12:00:00.000Z",
                        "precision": "hour"
                    }
                },
                "value": 110,
                "unit": "mg/dL",
                "status": "completed"
            }
        ],
        "results": [
            {
                "result_set": {
                    "name": "Glucose Level"
                },
                "results": [
                    {
                        "date_time": {
                            "point": {
                                "date": "2008-03-21T00:00:00.000Z",
                                "precision": "day"
                            }
                        },
                        "result": {
                            "name": "FBS"
                        },
                        "status": "completed",
                        "value": 135,
                        "unit": "mg/dL"
                    },
                    {
                        "date_time": {
                            "point": {
                                "date": "2008-03-21T00:00:00.000Z",
                                "precision": "day"
                            }
                        },
                        "result": {
                            "name": "RBS"
                        },
                        "status": "completed",
                        "value": 170,
                        "unit": "mg/dL"
                    },
                    {
                        "date_time": {
                            "point": {
                                "date": "2008-03-21T00:00:00.000Z",
                                "precision": "day"
                            }
                        },
                        "result": {
                            "name": "RBS"
                        },
                        "status": "completed",
                        "value": 150,
                        "unit": "mg/dL"
                    },
                    {
                        "date_time": {
                            "point": {
                                "date": "2008-03-21T00:00:00.000Z",
                                "precision": "day"
                            }
                        },
                        "result": {
                            "name": "RBS"
                        },
                        "status": "completed",
                        "value": 120,
                        "unit": "mg/dL"
                    }
                ]
            }
        ],
        "medications": [
            {
                "date_time": {},
                "product": {
                    "product": {
                        "name": "Aspirin"
                    },
                    "unencoded_name": "Aspirin"
                },
                "sig": "Aspirin",
                "status": "Completed"
            },
            {
                "date_time": {
                    "point": {
                        "date": "1949-09-28T00:00:00.000Z",
                        "precision": "day"
                    }
                },
                "product": {
                    "product": {
                        "name": "Erythromycin"
                    },
                    "unencoded_name": "Erythromycin"
                },
                "sig": "Erythromycin",
                "status": "Completed"
            }
        ],
        "allergies": [
            {
                "observation": {
                    "allergen": {
                        "name": "Antibotic"
                    },
                    "date_time": {
                        "low": {
                            "date": "1926-01-08T00:00:00.000Z",
                            "precision": "day"
                        },
                        "high": {
                            "date": "1955-03-13T00:00:00.000Z",
                            "precision": "day"
                        }
                    },
                    "reactions": [
                        {
                            "reaction": {
                                "name": "Vomiting"
                            },
                            "severity": {
                                "code": {
                                    "code": "24484000",
                                    "name": "Severe",
                                    "code_system_name": "SNOMED CT"
                                }
                            }
                        }
                    ],
                    "status": {
                        "name": "Active",
                        "code": "55561003",
                        "code_system_name": "SNOMED CT"
                    }
                }
            },
            {
                "observation": {
                    "allergen": {
                        "name": "Grasses"
                    },
                    "date_time": {
                        "low": {
                            "date": "1973-05-13T00:00:00.000Z",
                            "precision": "day"
                        },
                        "high": {
                            "date": "1996-07-20T00:00:00.000Z",
                            "precision": "day"
                        }
                    },
                    "reactions": [
                        {
                            "reaction": {
                                "name": "Sneezing"
                            },
                            "severity": {
                                "code": {
                                    "code": "24484000",
                                    "name": "Severe",
                                    "code_system_name": "SNOMED CT"
                                }
                            }
                        }
                    ],
                    "status": {
                        "name": "Active",
                        "code": "55561003",
                        "code_system_name": "SNOMED CT"
                    }
                }
            }
        ],
        "immunizations": [
            {
                "status": "complete",
                "administration": {
                    "route": {
                        "name": "Nasal Spray(mist)"
                    }
                },
                "product": {
                    "product": {
                        "name": "Varicella/Chicken Pox"
                    }
                },
                "date_time": {
                    "point": {
                        "date": "2002-04-21T00:00:00.000Z",
                        "precision": "day"
                    }
                }
            },
            {
                "status": "complete",
                "administration": {
                    "route": {
                        "name": "Nasal Spray(mist)"
                    }
                },
                "product": {
                    "product": {
                        "name": "Varicella/Chicken Pox (booster 1)"
                    }
                },
                "date_time": {
                    "point": {
                        "date": "1990-02-02T00:00:00.000Z",
                        "precision": "day"
                    }
                }
            },
            {
                "status": "complete",
                "administration": {
                    "route": {
                        "name": "Injection"
                    }
                },
                "product": {
                    "product": {
                        "name": "typhoid"
                    }
                },
                "date_time": {
                    "point": {
                        "date": "2009-01-02T00:00:00.000Z",
                        "precision": "day"
                    }
                }
            }
        ],
        "problems": [
            {
                "problem": {
                    "code": {
                        "name": "Arthritis"
                    }
                },
                "date_time": {
                    "low": {
                        "date": "2005-08-09T00:00:00.000Z",
                        "precision": "day"
                    },
                    "high": {
                        "date": "2011-02-28T00:00:00.000Z",
                        "precision": "day"
                    }
                }
            },
            {
                "problem": {
                    "code": {
                        "name": "Asthma"
                    }
                },
                "date_time": {
                    "low": {
                        "date": "2008-01-25T00:00:00.000Z",
                        "precision": "day"
                    },
                    "high": {
                        "date": "2010-01-25T00:00:00.000Z",
                        "precision": "day"
                    }
                }
            }
        ],
        "insurance": [
            {
                "plan_id": {
                    "identifier": "H9999/9999"
                },
                "payer_name": "HealthCare Payer",
                "type": [
                    "medicare",
                    "A Medicare Plan Plus (HMO)",
                    "3 - Coordinated Care Plan (HMO, PPO, PSO, SNP)"
                ],
                "addresses": [
                    {
                        "use": "primary home",
                        "street_lines": [
                            "123 Any Road"
                        ],
                        "city": "Anytown",
                        "state": "PA",
                        "zip": "00003",
                        "country": "United States"
                    }
                ],
                "date_time": {
                    "low": {
                        "date": "2011-09-01T00:00:00.000Z",
                        "precision": "day"
                    }
                }
            },
            {
                "plan_id": {
                    "identifier": "S9999/000"
                },
                "payer_name": "Another HealthCare Payer",
                "type": [
                    "medicare",
                    "A Medicare Rx Plan (PDP)",
                    "11 - Medicare Prescription Drug Plan"
                ],
                "addresses": [
                    {
                        "use": "primary home",
                        "street_lines": [
                            "123 Any Road"
                        ],
                        "city": "Anytown",
                        "state": "PA",
                        "zip": "00003",
                        "country": "United States"
                    }
                ],
                "date_time": {
                    "low": {
                        "date": "2010-01-01T00:00:00.000Z",
                        "precision": "day"
                    }
                }
            },
            {
                "plan_name": "STATE HEALTH BENEFITS PROGRAM",
                "type": [
                    "employer subsidy"
                ],
                "date_time": {
                    "low": {
                        "date": "2011-01-01T00:00:00.000Z",
                        "precision": "day"
                    },
                    "high": {
                        "date": "2011-12-31T00:00:00.000Z",
                        "precision": "day"
                    }
                }
            },
            {
                "policy_number": "1234567890",
                "payer_name": "Insurer1",
                "date_time": {
                    "low": {
                        "date": "2011-01-01T00:00:00.000Z",
                        "precision": "day"
                    },
                    "high": {
                        "date": "2011-09-30T00:00:00.000Z",
                        "precision": "day"
                    }
                },
                "type": [
                    "medicare msp:End stage Renal Disease (ESRD)"
                ],
                "addresses": [
                    {
                        "use": "primary home",
                        "street_lines": [
                            "PO BOX 0000"
                        ],
                        "city": "Anytown",
                        "state": "CO",
                        "zip": "00002-0000",
                        "country": "United States"
                    }
                ]
            },
            {
                "policy_number": "12345678901",
                "payer_name": "Insurer2",
                "date_time": {
                    "low": {
                        "date": "2010-01-01T00:00:00.000Z",
                        "precision": "day"
                    },
                    "high": {
                        "date": "2010-12-31T00:00:00.000Z",
                        "precision": "day"
                    }
                },
                "type": [
                    "medicare msp:End stage Renal Disease (ESRD)"
                ],
                "addresses": [
                    {
                        "use": "primary home",
                        "street_lines": [
                            "0000 Any ROAD"
                        ],
                        "city": "ANYWHERE",
                        "state": "VA",
                        "zip": "00000-0000",
                        "country": "United States"
                    }
                ]
            },
            {
                "policy_number": "00001",
                "payer_name": "Insurer",
                "date_time": {
                    "low": {
                        "date": "1984-10-01T00:00:00.000Z",
                        "precision": "day"
                    },
                    "high": {
                        "date": "2008-11-30T00:00:00.000Z",
                        "precision": "day"
                    }
                },
                "addresses": [
                    {
                        "use": "primary home",
                        "street_lines": [
                            "00 Address STREET"
                        ],
                        "city": "ANYWHERE",
                        "state": "PA",
                        "zip": "00000",
                        "country": "United States"
                    }
                ]
            }
        ],
        "claims": [
            {
                "payer": [
                    "medicare"
                ],
                "number": "1234567890000",
                "date_time": {
                    "low": {
                        "date": "2012-10-18T00:00:00.000Z",
                        "precision": "day"
                    },
                    "high": {
                        "date": "2012-10-18T00:00:00.000Z",
                        "precision": "day"
                    }
                },
                "lines": [
                    {
                        "line": "1",
                        "date_time": {
                            "low": {
                                "date": "2012-10-18T00:00:00.000Z",
                                "precision": "day"
                            },
                            "high": {
                                "date": "2012-10-18T00:00:00.000Z",
                                "precision": "day"
                            }
                        },
                        "procedure": {
                            "code": "98941",
                            "description": "Chiropractic Manipulative Treatment (Cmt); Spinal, Three To Four Regions"
                        },
                        "quantity": {
                            "value": 1,
                            "unit": "line"
                        },
                        "modifier": [
                            {
                                "code": "AT",
                                "description": "Acute Treatment (This Modifier Should Be Used When Reporting Service 98940, 98941, 98942)"
                            }
                        ],
                        "charges": {
                            "price_billed": "$60.00",
                            "insurance_paid": "$34.00",
                            "patient_responsibility": "$26.00"
                        },
                        "place_of_service": {
                            "code": "11",
                            "name": "Office"
                        },
                        "type": {
                            "code": "1",
                            "name": "Medical Care"
                        },
                        "performers": [
                            {
                                "type": "rendering provider",
                                "identifiers": [
                                    {
                                        "identifier": "2.16.840.1.113883.4.6",
                                        "extension": "123456789"
                                    }
                                ]
                            }
                        ]
                    }
                ],
                "charges": {
                    "price_billed": "$60.00",
                    "insurance_paid": "$34.00",
                    "provider_paid": "$27.20",
                    "patient_responsibility": "$6.80"
                },
                "type": [
                    "medicare PartB"
                ],
                "diagnosis": [
                    {
                        "code": "3534"
                    },
                    {
                        "code": "7393"
                    },
                    {
                        "code": "7392"
                    },
                    {
                        "code": "3533"
                    }
                ]
            },
            {
                "payer": [
                    "medicare"
                ],
                "number": "12345678900000VAA",
                "date_time": {
                    "low": {
                        "date": "2012-09-22T00:00:00.000Z",
                        "precision": "day"
                    }
                },
                "lines": [
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                        "line": "1",
                        "date_time": {
                            "low": {
                                "date": "2012-09-22T00:00:00.000Z",
                                "precision": "day"
                            }
                        },
                        "revenue": {
                            "code": "0250",
                            "description": "General Classification PHARMACY"
                        },
                        "quantity": {
                            "value": 1,
                            "unit": "line"
                        },
                        "charges": {
                            "price_billed": "$14.30",
                            "insurance_paid": "$14.30",
                            "patient_responsibility": "$0.00"
                        }
                    },
                    {
                        "line": "2",
                        "date_time": {
                            "low": {
                                "date": "2012-09-22T00:00:00.000Z",
                                "precision": "day"
                            }
                        },
                        "revenue": {
                            "code": "0320",
                            "description": "General Classification DX X"
                        },
                        "procedure": {
                            "code": "74020",
                            "description": "Radiologic Examination, Abdomen; Complete, Including Decubitus And/Or Erect Views"
                        },
                        "quantity": {
                            "value": 1,
                            "unit": "line"
                        },
                        "charges": {
                            "price_billed": "$175.50",
                            "insurance_paid": "$175.50",
                            "patient_responsibility": "$0.00"
                        }
                    },
                    {
                        "line": "3",
                        "date_time": {
                            "low": {
                                "date": "2012-09-22T00:00:00.000Z",
                                "precision": "day"
                            }
                        },
                        "revenue": {
                            "code": "0450",
                            "description": "General Classification EMERG ROOM"
                        },
                        "procedure": {
                            "code": "99283",
                            "description": "Emergency Department Visit For The Evaluation And Management Of A Patient, Which Requires Th"
                        },
                        "quantity": {
                            "value": 1,
                            "unit": "line"
                        },
                        "modifier": [
                            {
                                "code": "25",
                                "description": "Significant, Separately Identifiable Evaluation And Management Service By The Same Physician On"
                            }
                        ],
                        "charges": {
                            "price_billed": "$315.00",
                            "insurance_paid": "$315.00",
                            "patient_responsibility": "$0.00"
                        }
                    },
                    {
                        "line": "4",
                        "revenue": {
                            "code": "0001",
                            "description": "Total Charges"
                        },
                        "quantity": {
                            "value": 0,
                            "unit": "line"
                        },
                        "charges": {
                            "price_billed": "$504.80",
                            "insurance_paid": "$504.80",
                            "patient_responsibility": "$0.00"
                        }
                    }
                ],
                "charges": {
                    "price_billed": "$504.80",
                    "insurance_paid": "$504.80",
                    "provider_paid": "$126.31",
                    "patient_responsibility": "$38.84"
                },
                "type": [
                    "medicare Outpatient"
                ],
                "diagnosis": [
                    {
                        "code": "56400"
                    },
                    {
                        "code": "7245"
                    },
                    {
                        "code": "V1588"
                    }
                ]
            },
            {
                "payer": [
                    "medicare"
                ],
                "number": "1234567890123",
                "lines": [
                    {
                        "line": "1",
                        "date_time": {
                            "low": {
                                "date": "2012-12-01T00:00:00.000Z",
                                "precision": "day"
                            },
                            "high": {
                                "date": "2012-12-01T00:00:00.000Z",
                                "precision": "day"
                            }
                        },
                        "procedure": {
                            "code": "98941",
                            "description": "Chiropractic Manipulative Treatment, 3 To 4 Spinal Regions"
                        },
                        "quantity": {
                            "value": 1,
                            "unit": "line"
                        },
                        "modifier": [
                            {
                                "code": "GA",
                                "description": "Waiver Of Liability Statement Issued As Required By Payer Policy, Individual Case"
                            }
                        ],
                        "place_of_service": {
                            "code": "11",
                            "name": "Office"
                        },
                        "type": {
                            "code": "1",
                            "name": "Medical Care"
                        },
                        "performers": [
                            {
                                "type": "rendering provider",
                                "identifiers": [
                                    {
                                        "identifier": "2.16.840.1.113883.4.6",
                                        "extension": "123456789"
                                    }
                                ]
                            }
                        ]
                    },
                    {
                        "line": "2",
                        "date_time": {
                            "low": {
                                "date": "2012-12-01T00:00:00.000Z",
                                "precision": "day"
                            },
                            "high": {
                                "date": "2012-12-01T00:00:00.000Z",
                                "precision": "day"
                            }
                        },
                        "procedure": {
                            "code": "G0283",
                            "description": "Electrical Stimulation (Unattended), To One Or More Areas For Indication(S) Other Than Wound"
                        },
                        "quantity": {
                            "value": 1,
                            "unit": "line"
                        },
                        "modifier": [
                            {
                                "code": "GY",
                                "description": "Item Or Service Statutorily Excluded, Does Not Meet The Definition Of Any Medicare Benefit Or,"
                            }
                        ],
                        "place_of_service": {
                            "code": "11",
                            "name": "Office"
                        },
                        "type": {
                            "code": "1",
                            "name": "Medical Care"
                        },
                        "performers": [
                            {
                                "type": "rendering provider",
                                "identifiers": [
                                    {
                                        "identifier": "2.16.840.1.113883.4.6",
                                        "extension": "123456789"
                                    }
                                ]
                            }
                        ]
                    }
                ],
                "date_time": {
                    "low": {
                        "date": "2012-12-01T00:00:00.000Z",
                        "precision": "day"
                    },
                    "high": {
                        "date": "2012-12-01T00:00:00.000Z",
                        "precision": "day"
                    }
                }
            },
            {
                "payer": [
                    "medicare"
                ],
                "number": "123456789012",
                "date_time": {
                    "point": {
                        "date": "2011-11-17T00:00:00.000Z",
                        "precision": "day"
                    }
                },
                "type": [
                    "medicare Part D"
                ],
                "lines": [
                    {
                        "date_time": {
                            "point": {
                                "date": "2011-11-17T00:00:00.000Z",
                                "precision": "day"
                            }
                        },
                        "drug": {
                            "code": "00093013505",
                            "name": "CARVEDILOL"
                        },
                        "performers": [
                            {
                                "identifiers": [
                                    {
                                        "identifier": "2.16.840.1.113883.4.6",
                                        "extension": "123456789"
                                    }
                                ],
                                "type": "prescriber",
                                "name": [
                                    {
                                        "first": "Jane",
                                        "last": "Doe"
                                    }
                                ]
                            },
                            {
                                "type": "pharmacy",
                                "identifiers": [
                                    {
                                        "identifier": "2.16.840.1.113883.4.6",
                                        "extension": "123456789"
                                    }
                                ],
                                "name": [
                                    "PHARMACY2 #00000"
                                ]
                            }
                        ]
                    }
                ],
                "performers": [
                    {
                        "identifiers": [
                            {
                                "identifier": "2.16.840.1.113883.4.6",
                                "extension": "123456789"
                            }
                        ],
                        "type": "prescriber",
                        "name": [
                            {
                                "first": "Jane",
                                "last": "Doe"
                            }
                        ]
                    },
                    {
                        "type": "pharmacy",
                        "identifiers": [
                            {
                                "identifier": "2.16.840.1.113883.4.6",
                                "extension": "123456789"
                            }
                        ],
                        "name": [
                            "PHARMACY2 #00000"
                        ]
                    }
                ]
            },
            {
                "payer": [
                    "medicare"
                ],
                "number": "123456789011",
                "date_time": {
                    "point": {
                        "date": "2011-11-23T00:00:00.000Z",
                        "precision": "day"
                    }
                },
                "type": [
                    "medicare Part D"
                ],
                "lines": [
                    {
                        "date_time": {
                            "point": {
                                "date": "2011-11-23T00:00:00.000Z",
                                "precision": "day"
                            }
                        },
                        "drug": {
                            "code": "00781223310",
                            "name": "OMEPRAZOLE"
                        },
                        "performers": [
                            {
                                "identifiers": [
                                    {
                                        "identifier": "2.16.840.1.113883.4.6",
                                        "extension": "123456789"
                                    }
                                ],
                                "type": "prescriber",
                                "name": [
                                    {
                                        "first": "Jane",
                                        "last": "Doe"
                                    }
                                ]
                            },
                            {
                                "type": "pharmacy",
                                "identifiers": [
                                    {
                                        "identifier": "2.16.840.1.113883.4.6",
                                        "extension": "1234567890"
                                    }
                                ],
                                "name": [
                                    "PHARMACY3 #00000"
                                ]
                            }
                        ]
                    }
                ],
                "performers": [
                    {
                        "identifiers": [
                            {
                                "identifier": "2.16.840.1.113883.4.6",
                                "extension": "123456789"
                            }
                        ],
                        "type": "prescriber",
                        "name": [
                            {
                                "first": "Jane",
                                "last": "Doe"
                            }
                        ]
                    },
                    {
                        "type": "pharmacy",
                        "identifiers": [
                            {
                                "identifier": "2.16.840.1.113883.4.6",
                                "extension": "1234567890"
                            }
                        ],
                        "name": [
                            "PHARMACY3 #00000"
                        ]
                    }
                ]
            }
        ],
        "plan_of_care": [
            {
                "plan": {
                    "name": "DIABETES"
                },
                "type": "medicare",
                "date_time": {
                    "low": {
                        "date": "2011-10-01T00:00:00.000Z",
                        "precision": "day"
                    }
                }
            },
            {
                "plan": {
                    "name": "PAP TEST DR"
                },
                "type": "medicare",
                "date_time": {
                    "low": {
                        "date": "2011-10-01T00:00:00.000Z",
                        "precision": "day"
                    }
                }
            },
            {
                "plan": {
                    "name": "ABDOMINAL AORTIC ANEURYSM"
                },
                "type": "medicare",
                "date_time": {
                    "low": {
                        "date": "2012-07-01T00:00:00.000Z",
                        "precision": "day"
                    }
                }
            },
            {
                "plan": {
                    "name": "ANNUAL WELLNESS VISIT"
                },
                "type": "medicare",
                "date_time": {
                    "low": {
                        "date": "2013-01-01T00:00:00.000Z",
                        "precision": "day"
                    }
                }
            },
            {
                "plan": {
                    "name": "DEPRESSION SCREENING"
                },
                "type": "medicare",
                "date_time": {
                    "low": {
                        "date": "2012-10-14T00:00:00.000Z",
                        "precision": "day"
                    }
                }
            }
        ],
        "providers": [
            {
                "type": "organization",
                "name": "ANY CARE",
                "address": {
                    "use": "primary home",
                    "street_lines": [
                        "123 Any Rd"
                    ],
                    "city": "Anywhere",
                    "state": "MD",
                    "zip": "99999",
                    "country": "United States"
                },
                "role": {
                    "name": "NHC"
                }
            },
            {
                "type": "person",
                "address": {
                    "use": "primary home",
                    "street_lines": [
                        "123 Road"
                    ],
                    "city": "Anywhere",
                    "state": "VA",
                    "zip": "00001",
                    "country": "United States"
                },
                "role": {
                    "name": "PHY"
                },
                "person": {
                    "name": {
                        "first": "Jane",
                        "last": "Doe"
                    }
                }
            }
        ]
    },
    "meta": {
        "type": "cms",
        "version": "2.0",
        "timestamp": {
            "date": "2013-03-16T05:10:00.000Z",
            "precision": "minute"
        },
        "sections": [
            "demographics",
            "vitals",
            "results",
            "medications",
            "allergies",
            "immunizations",
            "problems",
            "insurance",
            "claims",
            "plan_of_care",
            "providers"
        ]
    },
    "interim": {
        "meta": {
            "data": [
                {
                    "type": "cms",
                    "version": "2.0",
                    "timestamp": {
                        "date": "2013-03-16T05:10:00.000Z",
                        "precision": "minute"
                    },
                    "sections": [
                        "demographics",
                        "vitals",
                        "results",
                        "medications",
                        "allergies",
                        "immunizations",
                        "problems",
                        "insurance",
                        "claims",
                        "plan_of_care",
                        "providers"
                    ]
                }
            ]
        },
        "demographic": {
            "source": "MyMedicare.gov",
            "data": [
                {
                    "name": "JOHN DOE",
                    "date of birth": "01/01/1910",
                    "address line 1": "123 ANY ROAD",
                    "address line 2": "",
                    "city": "ANYTOWN",
                    "state": "VA",
                    "zip": "00001",
                    "phone number": "123-456-7890",
                    "email": "JOHNDOE@example.com",
                    "part a effective date": "01/01/2012",
                    "part b effective date": "01/01/2012"
                }
            ]
        },
        "emergency contact": {
            "source": "Self-Entered",
            "data": [
                {
                    "contact name": "JANE DOE",
                    "address type": "Home",
                    "address line 1": "123 AnyWhere St",
                    "address line 2": "",
                    "city": "AnyWhere",
                    "state": "DC",
                    "zip": "00002-1111",
                    "relationship": "Other",
                    "home phone": "123-456-7890",
                    "work phone": "000-001-0001",
                    "mobile phone": "000-001-0002",
                    "email address": "JANEDOE@example.com"
                },
                {
                    "contact name": "STEVE DOE",
                    "address type": "",
                    "address line 1": "123 AnyWhere Rd",
                    "address line 2": "",
                    "city": "AnyWhere",
                    "state": "VA",
                    "zip": "00001",
                    "relationship": "Other",
                    "home phone": "123-456-7890",
                    "work phone": "000-001-0001",
                    "mobile phone": "000-001-0002",
                    "email address": "STEVEDOE@example.com"
                }
            ]
        },
        "self reported medical conditions": {
            "source": "Self-Entered",
            "data": [
                {
                    "condition name": "Arthritis",
                    "medical condition start date": "08/09/2005",
                    "medical condition end date": "02/28/2011"
                },
                {
                    "condition name": "Asthma",
                    "medical condition start date": "01/25/2008",
                    "medical condition end date": "01/25/2010"
                }
            ]
        },
        "self reported allergies": {
            "source": "Self-Entered",
            "data": [
                {
                    "allergy name": "Antibotic",
                    "type": "Drugs",
                    "diagnosed": "Yes",
                    "treatment": "Allergy Shots",
                    "first episode date": "01/08/1926",
                    "last episode date": "03/13/1955",
                    "last treatment date": "09/28/1949",
                    "comments": "Erythromycin"
                },
                null
            ]
        },
        "self reported implantable device": {
            "source": "Self-Entered",
            "data": [
                {
                    "device name": "Artificial Eye Lenses",
                    "date implanted": "1/27/1942"
                }
            ]
        },
        "self reported immunizations": {
            "source": "Self-Entered",
            "data": [
                {
                    "immunization name": "Varicella/Chicken Pox",
                    "date administered": "04/21/2002",
                    "method": "Nasal Spray(mist)",
                    "were you vaccinated in the us": "",
                    "comments": "congestion",
                    "booster 1 date": "02/02/1990",
                    "booster 2 date": "",
                    "booster 3 date": ""
                },
                {
                    "immunization name": "typhoid",
                    "date administered": "01/02/2009",
                    "method": "Injection",
                    "were you vaccinated in the us": "",
                    "comments": "",
                    "booster 1 date": "",
                    "booster 2 date": "",
                    "booster 3 date": ""
                }
            ]
        },
        "self reported labs and tests": {
            "source": "Self-Entered",
            "data": [
                {
                    "test/lab type": "Glucose Level",
                    "date taken": "03/21/2008",
                    "administered by": "AnyLab",
                    "requesting doctor": "Dr. Smith",
                    "reason test/lab requested": "Ongoing elevated glucose",
                    "results": "135, 170, 150, 120",
                    "comments": "Fasting, hour 1, hour 2, hour 3"
                }
            ]
        },
        "self reported vital statistics": {
            "source": "Self-Entered",
            "data": [
                {
                    "vital statistic type": "Blood Pressure",
                    "date": "07/22/2011",
                    "time": "3:00 PM",
                    "reading": "120/80",
                    "comments": ""
                },
                {
                    "vital statistic type": "Glucose",
                    "date": "03/20/2012",
                    "time": "12:00 PM",
                    "reading": "110",
                    "comments": ""
                }
            ]
        },
        "family medical history": {
            "source": "Self-Entered",
            "data": [
                {
                    "family member": "Brother",
                    "type": "",
                    "dob": "1/10/1915",
                    "dod": "",
                    "age": "",
                    "type 1": "Allergy",
                    "description": "Antiarrythmia",
                    "description 1": "Antibiotic",
                    "description 2": "Anticonvulsants",
                    "type 2": "Condition",
                    "description 3": "Allergies",
                    "description 4": "Alzheimer's Disease",
                    "description 5": "Angina (Heart Pain)",
                    "description 6": "Cataracts"
                }
            ]
        },
        "drugs": {
            "source": "Self-Entered",
            "data": [
                {
                    "drug name": "Aspirin",
                    "supply": "Dialy",
                    "orig drug entry": "Aspirin"
                }
            ]
        },
        "preventive services": {
            "source": "MyMedicare.gov",
            "data": [
                {
                    "description": "DIABETES",
                    "next eligible date": "10/1/2011",
                    "last date of service": ""
                },
                {
                    "description": "PAP TEST DR",
                    "next eligible date": "10/1/2011",
                    "last date of service": ""
                },
                {
                    "description": "ABDOMINAL AORTIC ANEURYSM",
                    "next eligible date": "7/1/2012",
                    "last date of service": ""
                },
                {
                    "description": "ANNUAL WELLNESS VISIT",
                    "next eligible date": "1/1/2013",
                    "last date of service": ""
                },
                {
                    "description": "DEPRESSION SCREENING",
                    "next eligible date": "10/14/2012",
                    "last date of service": ""
                }
            ]
        },
        "providers": {
            "source": "Self-Entered",
            "data": [
                {
                    "provider name": "ANY CARE",
                    "provider address": "123 Any Rd, Anywhere, MD 99999",
                    "type": "NHC",
                    "specialty": "",
                    "medicare provider": "Not Available"
                },
                {
                    "provider name": "ANY HOSPITAL1",
                    "provider address": "123 Drive, Anywhere, VA 00001",
                    "type": "HOS",
                    "specialty": "",
                    "medicare provider": "Not Available",
                    "provider name 1": "Jane Doe",
                    "provider address 1": "123 Road, Anywhere, VA 00001",
                    "type 1": "PHY",
                    "specialty 1": "Other",
                    "medicare provider 1": "Not Available"
                }
            ]
        },
        "pharmacies": {
            "source": "Self-Entered",
            "data": [
                {
                    "pharmacy name": "PHARMACY, EAST STREET ANYWHERE, DC 00002",
                    "pharmacy phone": "000-000-0001"
                },
                {
                    "pharmacy name": "ANY PHARMACY, WEST STREET ANYWHERE, VA 00001",
                    "pharmacy phone": "000-000-0002"
                }
            ]
        },
        "plans": {
            "source": "MyMedicare.gov",
            "data": [
                {
                    "contract id/plan id": "H9999/9999",
                    "plan period": "09/01/2011 - current",
                    "plan name": "A Medicare Plan Plus (HMO)",
                    "marketing name": "HealthCare Payer",
                    "plan address": "123 Any Road Anytown PA 00003",
                    "plan type": "3 - Coordinated Care Plan (HMO, PPO, PSO, SNP)"
                },
                {
                    "contract id/plan id": "S9999/000",
                    "plan period": "01/01/2010 - current",
                    "plan name": "A Medicare Rx Plan (PDP)",
                    "marketing name": "Another HealthCare Payer",
                    "plan address": "123 Any Road Anytown PA 00003",
                    "plan type": "11 - Medicare Prescription Drug Plan"
                }
            ]
        },
        "employer subsidy": {
            "source": "MyMedicare.gov",
            "data": [
                {
                    "employer plan": "STATE HEALTH BENEFITS PROGRAM",
                    "employer subsidy start date": "01/01/2011",
                    "employer subsidy end date": "12/31/2011"
                }
            ]
        },
        "primary insurance": {
            "source": "MyMedicare.gov",
            "data": [
                {
                    "msp type": "End stage Renal Disease (ESRD)",
                    "policy number": "1234567890",
                    "insurer name": "Insurer1",
                    "insurer address": "PO BOX 0000 Anytown, CO 00002-0000",
                    "effective date": "01/01/2011",
                    "termination date": "09/30/2011"
                },
                {
                    "msp type": "End stage Renal Disease (ESRD)",
                    "policy number": "12345678901",
                    "insurer name": "Insurer2",
                    "insurer address": "0000 Any ROAD ANYWHERE, VA 00000-0000",
                    "effective date": "01/01/2010",
                    "termination date": "12/31/2010"
                }
            ]
        },
        "other insurance": {
            "source": "MyMedicare.gov",
            "data": [
                {
                    "msp type": "",
                    "policy number": "00001",
                    "insurer name": "Insurer",
                    "insurer address": "00 Address STREET ANYWHERE, PA 00000",
                    "effective date": "10/01/1984",
                    "termination date": "11/30/2008"
                }
            ]
        },
        "claim summary": {
            "source": "MyMedicare.gov",
            "data": [
                {
                    "claim number": "1234567890000",
                    "provider": "No Information Available",
                    "provider billing address": null,
                    "service start date": "10/18/2012",
                    "service end date": null,
                    "amount charged": "$60.00",
                    "medicare approved": "$34.00",
                    "provider paid": "$27.20",
                    "you may be billed": "$6.80",
                    "claim type": "PartB",
                    "diagnosis code 1": "3534",
                    "diagnosis code 2": "7393",
                    "diagnosis code 3": "7392",
                    "diagnosis code 4": "3533",
                    "claimLines": [
                        {
                            "line number": "1",
                            "date of service from": "10/18/2012",
                            "date of service to": "10/18/2012",
                            "procedure code/description": "98941 - Chiropractic Manipulative Treatment (Cmt); Spinal, Three To Four Regions",
                            "modifier 1/description": "AT - Acute Treatment (This Modifier Should Be Used When Reporting Service 98940, 98941, 98942)",
                            "modifier 2/description": null,
                            "modifier 3/description": null,
                            "modifier 4/description": null,
                            "quantity billed/units": "1",
                            "submitted amount/charges": "$60.00",
                            "allowed amount": "$34.00",
                            "noncovered": "$26.00",
                            "place of service/description": "11 - Office",
                            "type of service/description": "1 - Medical Care",
                            "rendering provider no": "0000001",
                            "rendering provider npi": "123456789"
                        }
                    ]
                },
                {
                    "claim number": "12345678900000VAA",
                    "provider": "No Information Available",
                    "provider billing address": null,
                    "service start date": "09/22/2012",
                    "service end date": null,
                    "amount charged": "$504.80",
                    "medicare approved": "$504.80",
                    "provider paid": "$126.31",
                    "you may be billed": "$38.84",
                    "claim type": "Outpatient",
                    "diagnosis code 1": "56400",
                    "diagnosis code 2": "7245",
                    "diagnosis code 3": "V1588",
                    "claimLines": [
                        {
                            "line number": "1",
                            "date of service from": "09/22/2012",
                            "revenue code/description": "0250 - General Classification PHARMACY",
                            "procedure code/description": null,
                            "modifier 1/description": null,
                            "modifier 2/description": null,
                            "modifier 3/description": null,
                            "modifier 4/description": null,
                            "quantity billed/units": "1",
                            "submitted amount/charges": "$14.30",
                            "allowed amount": "$14.30",
                            "noncovered": "$0.00"
                        },
                        {
                            "line number": "2",
                            "date of service from": "09/22/2012",
                            "revenue code/description": "0320 - General Classification DX X-RAY",
                            "procedure code/description": "74020 - Radiologic Examination, Abdomen; Complete, Including Decubitus And/Or Erect Views",
                            "modifier 1/description": null,
                            "modifier 2/description": null,
                            "modifier 3/description": null,
                            "modifier 4/description": null,
                            "quantity billed/units": "1",
                            "submitted amount/charges": "$175.50",
                            "allowed amount": "$175.50",
                            "noncovered": "$0.00"
                        },
                        {
                            "line number": "3",
                            "date of service from": "09/22/2012",
                            "revenue code/description": "0450 - General Classification EMERG ROOM",
                            "procedure code/description": "99283 - Emergency Department Visit For The Evaluation And Management Of A Patient, Which Requires Th",
                            "modifier 1/description": "25 - Significant, Separately Identifiable Evaluation And Management Service By The Same Physician On",
                            "modifier 2/description": null,
                            "modifier 3/description": null,
                            "modifier 4/description": null,
                            "quantity billed/units": "1",
                            "submitted amount/charges": "$315.00",
                            "allowed amount": "$315.00",
                            "noncovered": "$0.00"
                        },
                        {
                            "line number": "4",
                            "date of service from": null,
                            "revenue code/description": "0001 - Total Charges",
                            "procedure code/description": null,
                            "modifier 1/description": null,
                            "modifier 2/description": null,
                            "modifier 3/description": null,
                            "modifier 4/description": null,
                            "quantity billed/units": "0",
                            "submitted amount/charges": "$504.80",
                            "allowed amount": "$504.80",
                            "noncovered": "$0.00",
                            "claim number": "1234567890123",
                            "provider": "No Information Available",
                            "provider billing address": null,
                            "service start date": "12/01/2012",
                            "service end date": null,
                            "amount charged": "* Not Available *",
                            "medicare approved": "* Not Available *",
                            "provider paid": "* Not Available *",
                            "you may be billed": "* Not Available *",
                            "claim type": "PartB",
                            "diagnosis code 1": "7392",
                            "diagnosis code 2": "7241",
                            "diagnosis code 3": "7393",
                            "diagnosis code 4": "7391"
                        }
                    ]
                },
                {
                    "claim number": "1234567890123",
                    "claimLines": [
                        {
                            "line number": "1",
                            "date of service from": "12/01/2012",
                            "date of service to": "12/01/2012",
                            "procedure code/description": "98941 - Chiropractic Manipulative Treatment, 3 To 4 Spinal Regions",
                            "modifier 1/description": "GA - Waiver Of Liability Statement Issued As Required By Payer Policy, Individual Case",
                            "modifier 2/description": null,
                            "modifier 3/description": null,
                            "modifier 4/description": null,
                            "quantity billed/units": "1",
                            "submitted amount/charges": "* Not Available *",
                            "allowed amount": "* Not Available *",
                            "noncovered": "* Not Available *",
                            "place of service/description": "11 - Office",
                            "type of service/description": "1 - Medical Care",
                            "rendering provider no": "123456",
                            "rendering provider npi": "123456789"
                        },
                        {
                            "line number": "2",
                            "date of service from": "12/01/2012",
                            "date of service to": "12/01/2012",
                            "procedure code/description": "G0283 - Electrical Stimulation (Unattended), To One Or More Areas For Indication(S) Other Than Wound",
                            "modifier 1/description": "GY - Item Or Service Statutorily Excluded, Does Not Meet The Definition Of Any Medicare Benefit Or,",
                            "modifier 2/description": null,
                            "modifier 3/description": null,
                            "modifier 4/description": null,
                            "quantity billed/units": "1",
                            "submitted amount/charges": "* Not Available *",
                            "allowed amount": "* Not Available *",
                            "noncovered": "* Not Available *",
                            "place of service/description": "11 - Office",
                            "type of service/description": "1 - Medical Care",
                            "rendering provider no": "123456",
                            "rendering provider npi": "123456789"
                        }
                    ]
                },
                {
                    "claim number": "123456789012",
                    "claimLines": [
                        {
                            "claim type": "Part D",
                            "claim number": "123456789012",
                            "claim service date": "11/17/2011",
                            "pharmacy / service provider": "123456789",
                            "pharmacy name": "PHARMACY2 #00000",
                            "drug code": "00093013505",
                            "drug name": "CARVEDILOL",
                            "fill number": "0",
                            "days' supply": "30",
                            "prescriber identifer": "123456789",
                            "prescriber name": "Jane Doe"
                        }
                    ]
                },
                {
                    "claim number": "123456789011",
                    "claimLines": [
                        {
                            "claim type": "Part D",
                            "claim number": "123456789011",
                            "claim service date": "11/23/2011",
                            "pharmacy / service provider": "1234567890",
                            "pharmacy name": "PHARMACY3 #00000",
                            "drug code": "00781223310",
                            "drug name": "OMEPRAZOLE",
                            "fill number": "4",
                            "days' supply": "30",
                            "prescriber identifer": "123456789",
                            "prescriber name": "Jane Doe"
                        }
                    ]
                }
            ]
        }
    }
}
[ 'demographics',
  'vitals',
  'results',
  'medications',
  'allergies',
  'immunizations',
  'problems',
  'insurance',
  'claims',
  'plan_of_care',
  'providers' ]
---
false
{
    "valid": true,
    "errors": [],
    "warnings": []
}