{"text_format":"3","workbook":"xlsx","n_sheets":2,"sheets":["Sheet1","DESCRIPTIONS OF EACH FIELD"],"read":"whole","date_system":"1900"}

{"sheet":"Sheet1","index":0,"n_rows":1,"n_cols":38,"rows_kept":1}
["Patient ID","ClaimID","Company","ResponsibleParty Lastname","ResponsibleParty MI","ResponsibleParty FirstName","ResponsibleParty DOB","ResponsibleParty SSN","ResponsibleParty PrimaryPhone","ResponsibleParty WorkPhone","ResponsibleParty AltPhone","ResponsibleParty Address1","ResponsibleParty Address2","ResponsibleParty City","ResponsibleParty State","ResponsibleParty Zip","ResponsibleParty Email","ResponsibleParty Employment","Patient LastName","Patient MI","Patient FirstName","Patient DOB","Patient SSN","Patient Address","Patient City","Patient State","Patient Zip","Balance Owed","Date of Service","Date of Last Payment","PrimaryInsurance","SecondaryInsurance","Insurance Subscriber","Policy Number","Notes","Client Location","Attending Doctor","In Network? "]

{"sheet":"DESCRIPTIONS OF EACH FIELD","index":1,"n_rows":30,"n_cols":38,"rows_kept":30,"merged":[[29,2,29,15]]}
["Patient ID","ClaimID","Company","ResponsibleParty Lastname","ResponsibleParty MI","ResponsibleParty FirstName","ResponsibleParty DOB","ResponsibleParty SSN","ResponsibleParty PrimaryPhone","ResponsibleParty WorkPhone","ResponsibleParty AltPhone","ResponsibleParty Address1","ResponsibleParty Address2","ResponsibleParty City","ResponsibleParty State","ResponsibleParty Zip","ResponsibleParty Email","ResponsibleParty Employment","Patient LastName","Patient MI","Patient FirstName","Patient DOB","Patient SSN","Patient Address","Patient City","Patient State","Patient Zip","Balance Owed","Date of Service","Date of Last Payment","PrimaryInsurance","SecondaryInsurance","Insurance Subscriber","Policy Number","Notes","Client Location","Attending Doctor","In Network ?"]
["This is your account number that you use to reference and identify this patient/customer","Claim or Encounter number that can be found on the claim submitted to the insurance.",null,"Last name of the responsible party or guarantor ","Middle Initial of the responsible party or guarantor ","First name of the responsible party or guarantor ","Date of Birth Month/date/year (mm/dd/yy) for responsible party or guarantor ","Full 9 digit Social Security Number for the  responsible party or guarantor ","10 digit home phone number for responsible party or guarantor","10 digit work phone number for responsible party or guarantor","10 digit alternative phone number for responsible party or guarantor","Street address of reponsible party or guarantor","Secondary Street address of reponsible party or guarantor","City of responsible party or guarantor","2 letter state abbreviation of responsible party or guarantor address","5 digit zip code of responsible party or guarantor address","Email for the responsible party or guarantor address","Name of workplace of responsible party or guarantor","Last name of patient (if different from responsible party or guarantor)","Middle Initial of patient (if different from responsible party or guarantor)","First name of patient (if different from responsible party or guarantor)","Date of Birth Month/date/year (mm/dd/yy) for the patient (if different from the responsible party or guarantor)","Full 9 digit Social Security Number for the  patient (If different from responsible party or guarantor)","Street address of the patient (if different from responsible party or guarantor)","City of the patient (if different from responsible party or guarantor)","2 letter state abbreviation of patient (if different from responsible party or guarantor)","5 digit zip code of patient (If different from responsinble party or guarantor)","Total Amount Owed","Service date (date for which service was rendered or purchase was made)","Date of last payment ?","Name of Primary Insurance Company","Name of Secondary Insurance Company","Name of Individual Holding Primary Insurance Coverage",null,"Additional information pertaining to the date of service","Location of Office where Service was Provided","Name of Primary Doctor or Service Provider","Yes / No answer in regards to whether the date of service mentioned was In-Network during the time of service. "]
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[12345678,12345,null,"Smith","A","John","2001-01-01",123456789,"555-555-1234","555-555-1234","555-555-1234","123 MAIN ST",null,"NEW YORK","NY",{"v":12345,"d":"12345.00"},"JOHNASMITH@EXAMPLE.COM","WALMART","SMITH",null,"Jane","2001-01-01",123456789,"1234 1ST STREET","NEW YORK","NY",12345,1000,"2018-01-01","2019-01-01","MVP Healthcare","Medicaid","John Smith","1-23456",null,"ABC Medical Center","Jones, MD","Yes "]
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["Fields Highlighted in Yellow are \"Required Fields\""]
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["Columns D through R reflect the information for the person or company identified as responsible for paying the debt - this is the responsible party's information."]
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["Columns S and AA reflect the information for the patient for which services were rendered or performed (if different than responsible party)"]
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["Columns AB through AK reflect the information for services rendered to the patient, including insurance information, location and doctor."]
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["Column AL is necessary for all patients who reside in Texas. If this is not filled out, we will be forced to default the answer to No, which will not allow the patients service to Credit Report. "]
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[{"$nulls":3},"***PLEASE PLACE YOUR ACCOUNTS ON THE \"FIRST\" TAB***"]
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[{"$nulls":3},"***PLEASE DO NOT CHANGE COLUMN HEADERS IN THE \"FIRST\" TAB***"]
{"$rows_empty":8}
[null,null,"This is Simons Medical Placement Template Version 4.0.  Released on 2020-4-9"]