src/applications/personalization/dashboard/mocks/medical-copays/index.js
const has3Copays = {
data: [
{
id: '53a48388-38d3-41da-a187-b7680462db4c',
pSSeqNum: 1,
pSTotSeqNum: 1,
pSFacilityNum: '757',
pSFacPhoneNum: null,
pSTotStatement: 11,
pSStatementVal: '0000040520F',
pSStatementDate: '07142022',
pSStatementDateOutput: '07/14/2022',
pSProcessDate: '07142022',
pSProcessDateOutput: '07/14/2022',
pHPatientLstNme: 'Joe',
pHPatientFstNme: 'Twothree',
pHPatientMidNme: 'James',
pHAddress1: '2890 BLACK RIDGE DR',
pHAddress2: null,
pHAddress3: null,
pHCity: 'KANSAS CITY',
pHState: 'MO',
pHZipCde: '641172521',
pHZipCdeOutput: '64117-2521',
pHCtryNme: 'US',
pHAmtDue: 41.42,
pHAmtDueOutput: '41.42 ',
pHPrevBal: 0,
pHPrevBalOutput: '.00 ',
pHTotCharges: 0,
pHTotChargesOutput: '.00 ',
pHTotCredits: 0,
pHTotCreditsOutput: '.00 ',
pHNewBalance: 49.56,
pHNewBalanceOutput: '49.56 ',
pHSpecialNotes: null,
pHroParaCdes: null,
pHNumOfLines: 8,
pHDfnNumber: 0,
pHCernerStatementNumber: 1007697216,
pHCernerPatientId: '1007697216',
pHCernerAccountNumber: '7571001007697216',
pHIcnNumber: '1008794179V018445',
pHAccountNumber: 0,
pHLargeFontIndcator: 0,
details: [
{
pDDatePosted: '07142022',
pDDatePostedOutput: '07/14/2022',
pDTransDesc: 'COPAY RX302150000064 FILL DATE:',
pDTransDescOutput:
' COPAY RX302150000064 FILL DATE:',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: '1717968-1',
},
{
pDDatePosted: '07142022',
pDDatePostedOutput: '07/14/2022',
pDTransDesc: 'DRUG: escitalopram 10 mg tablet',
pDTransDescOutput:
' DRUG: escitalopram 10 mg tablet',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: '07142022',
pDDatePostedOutput: '07/14/2022',
pDTransDesc: 'DAYS: 30 QTY: 30',
pDTransDescOutput: ' DAYS: 30 QTY: 30',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: '07142022',
pDDatePostedOutput: '07/14/2022',
pDTransDesc: 'PHY: VA-Physician Ambulatory1',
pDTransDescOutput: ' PHY: VA-Physician Ambulatory1',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: '07142022',
pDDatePostedOutput: '07/14/2022',
pDTransDesc: 'COPAY RX302120000007 FILL DATE: 05/07/2021:13:12',
pDTransDescOutput:
' COPAY RX302120000007 FILL DATE: 05/07/2021:13:12',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: '1717968-2',
},
{
pDDatePosted: '07142022',
pDDatePostedOutput: '07/14/2022',
pDTransDesc: 'DRUG: oxyCODONE-acetaminophen 5 mg-325 mg tablet',
pDTransDescOutput:
' DRUG: oxyCODONE-acetaminophen 5 mg-325 mg tablet',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: '07142022',
pDDatePostedOutput: '07/14/2022',
pDTransDesc: 'DAYS: 10 QTY: 30',
pDTransDescOutput: ' DAYS: 10 QTY: 30',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: '05072020',
pDDatePostedOutput: '05/07/2020',
pDTransDesc: 'PHY: VA-Physician PCP1',
pDTransDescOutput: ' PHY: VA-Physician PCP1',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
],
station: {
facilitYNum: '757',
visNNum: '10',
facilitYDesc: 'CHALMERS P WYLIE VA ACC (757)',
cyclENum: '004',
remiTToFlag: 'L',
maiLInsertFlag: '0',
staTAddress1: '420 N JAMES RD',
staTAddress2: null,
staTAddress3: null,
city: 'COLUMBUS',
state: 'OH',
ziPCde: '432191834',
ziPCdeOutput: '43219-1834',
baRCde: '*432191834203*',
teLNumFlag: 'S',
teLNum: '1-866-812-0318',
teLNum2: null,
contacTInfo: null,
dM2TelNum: null,
contacTInfo2: null,
toPTelNum: null,
lbXFedexAddress1: null,
lbXFedexAddress2: null,
lbXFedexAddress3: null,
lbXFedexCity: null,
lbXFedexState: null,
lbXFedexZipCde: null,
lbXFedexBarCde: null,
lbXFedexContact: null,
lbXFedexContactTelNum: null,
},
},
{
id: '0e23dbf3-5c6b-4ac1-9b0c-f18a31f620d5',
pSSeqNum: 1,
pSTotSeqNum: 1,
pSFacilityNum: '757',
pSFacPhoneNum: null,
pSTotStatement: 11,
pSStatementVal: '0000040520F',
pSStatementDate: '11292020',
pSStatementDateOutput: '11/29/2020',
pSProcessDate: '12092020',
pSProcessDateOutput: '12/09/2020',
pHPatientLstNme: 'MARSHALL',
pHPatientFstNme: 'FLOYD',
pHPatientMidNme: 'E',
pHAddress1: '136 HIGHVIEW CV',
pHAddress2: null,
pHAddress3: null,
pHCity: 'Dublin',
pHState: 'OH',
pHZipCde: '430175048',
pHZipCdeOutput: '43017-5048',
pHCtryNme: 'US',
pHAmtDue: 217.8,
pHAmtDueOutput: '217.80 ',
pHPrevBal: 0,
pHPrevBalOutput: '.00 ',
pHTotCharges: 0,
pHTotChargesOutput: '.00 ',
pHTotCredits: 0,
pHTotCreditsOutput: '.00 ',
pHNewBalance: 98.71,
pHNewBalanceOutput: '98.71 ',
pHSpecialNotes: null,
pHroParaCdes: null,
pHNumOfLines: 9,
pHDfnNumber: 0,
pHCernerStatementNumber: 1007697216,
pHCernerPatientId: '1007697216',
pHCernerAccountNumber: '7571001007697216',
pHIcnNumber: '1012858706V701334',
pHAccountNumber: 0,
pHLargeFontIndcator: 0,
details: [
{
pDDatePosted: '11102020',
pDDatePostedOutput: '11/10/2020',
pDTransDesc: 'COPAY RX302150000027 FILL DATE: 02/10/2021:15:06',
pDTransDescOutput:
' COPAY RX302150000027 FILL DATE: 02/10/2021:15:06',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: 'LPE21088081630000-1',
},
{
pDDatePosted: '11062020',
pDDatePostedOutput: '11/06/2020',
pDTransDesc: 'DRUG: ocular lubricant 1.4%-0.6% (PF) eye drops',
pDTransDescOutput:
' DRUG: ocular lubricant 1.4%-0.6% (PF) eye drops',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: '02102020',
pDDatePostedOutput: '02/10/2020',
pDTransDesc: 'DAYS: 15 QTY: 30',
pDTransDescOutput: ' DAYS: 15 QTY: 30',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: '08102020',
pDDatePostedOutput: '08/10/2020',
pDTransDesc: 'PHY: VA-Physician PCP30',
pDTransDescOutput: ' PHY: VA-Physician PCP30',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: '09082020',
pDDatePostedOutput: '09/08/2020',
pDTransDesc: 'COPAY RX302150000041 FILL DATE: 03/03/2021:11:25',
pDTransDescOutput:
' COPAY RX302150000041 FILL DATE: 03/03/2021:11:25',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: 'LPE21088081630000-2',
},
{
pDDatePosted: '09032020',
pDDatePostedOutput: '09/03/2020',
pDTransDesc: 'DRUG: PEG-400 0.4%/prop gly 0.3% eye drops [30mL',
pDTransDescOutput:
' DRUG: PEG-400 0.4%/prop gly 0.3% eye drops [30mL',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: '11032020',
pDDatePostedOutput: '11/03/2020',
pDTransDesc: 'DAYS: 15 QTY: 30',
pDTransDescOutput: ' DAYS: 15 QTY: 30',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: '10032020',
pDDatePostedOutput: '10/03/2020',
pDTransDesc: 'PHY: VA-Physician Ophthalmologist30',
pDTransDescOutput:
' PHY: VA-Physician Ophthalmologist30',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: '10082020',
pDDatePostedOutput: '10/08/2020',
pDTransDesc: 'Patient Responsibility Adjustment',
pDTransDescOutput:
' Patient Responsibility Adjustment',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: 'LPE21088081630000-2',
},
],
station: {
facilitYNum: '757',
visNNum: '10',
facilitYDesc: 'CHALMERS P WYLIE VA ACC (757)',
cyclENum: '004',
remiTToFlag: 'L',
maiLInsertFlag: '0',
staTAddress1: '420 N JAMES RD',
staTAddress2: null,
staTAddress3: null,
city: 'COLUMBUS',
state: 'OH',
ziPCde: '432191834',
ziPCdeOutput: '43219-1834',
baRCde: '*432191834203*',
teLNumFlag: 'S',
teLNum: '1-866-812-0318',
teLNum2: null,
contacTInfo: null,
dM2TelNum: null,
contacTInfo2: null,
toPTelNum: null,
lbXFedexAddress1: null,
lbXFedexAddress2: null,
lbXFedexAddress3: null,
lbXFedexCity: null,
lbXFedexState: null,
lbXFedexZipCde: null,
lbXFedexBarCde: null,
lbXFedexContact: null,
lbXFedexContactTelNum: null,
},
},
{
id: 'a872f2a9-12cc-497e-905b-db2fa2ab844d',
pSSeqNum: 27,
pSTotSeqNum: 31,
pSFacilityNum: '668',
pSFacPhoneNum: '(509)434-7000',
pSTotStatement: 53,
pSStatementVal: '0000050090{',
pSStatementDate: '05042022',
pSStatementDateOutput: '05/04/2022',
pSProcessDate: '05042022',
pSProcessDateOutput: '05/04/2022',
pHPatientLstNme: 'ROMII',
pHPatientFstNme: 'ROCK',
pHPatientMidNme: '',
pHAddress1: '2092 N CHEVY',
pHAddress2: null,
pHAddress3: null,
pHCity: 'POST FALLS',
pHState: 'ID',
pHZipCde: '838547724',
pHZipCdeOutput: '83854-7724',
pHCtryNme: 'US',
pHAmtDue: 65,
pHAmtDueOutput: '65.00 ',
pHPrevBal: 0,
pHPrevBalOutput: '.00 ',
pHTotCharges: 65,
pHTotChargesOutput: '65.00 ',
pHTotCredits: 0,
pHTotCreditsOutput: '.00 ',
pHNewBalance: 65,
pHNewBalanceOutput: '65.00 ',
pHSpecialNotes: null,
pHroParaCdes: null,
pHNumOfLines: 6,
pHDfnNumber: 0,
pHCernerStatementNumber: 1007697216,
pHCernerPatientId: '1007697216',
pHCernerAccountNumber: '6681001007697216',
pHIcnNumber: '1001179878V046936',
pHAccountNumber: 0,
pHLargeFontIndcator: 0,
details: [
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'Outpatient-Ophthalmology',
pDTransDescOutput: 'Outpatient-Ophthalmology',
pDTransAmt: 50,
pDTransAmtOutput: '50.00 ',
pDRefNo: '21191912',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: '668 Mann-Grandstaff WA VA Medical Center',
pDTransDescOutput:
' 668 Mann-Grandstaff WA VA Medical Center',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'VISIT_DT 03/21/2022',
pDTransDescOutput: ' VISIT_DT 03/21/2022',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'Outpatient-Respiratory Therapy',
pDTransDescOutput: 'Outpatient-Respiratory Therapy',
pDTransAmt: 15,
pDTransAmtOutput: '15.00 ',
pDRefNo: '27235423',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: '668 Mann-Grandstaff WA VA Medical Center',
pDTransDescOutput:
' 668 Mann-Grandstaff WA VA Medical Center',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'VISIT_DT 04/13/2022',
pDTransDescOutput: ' VISIT_DT 04/13/2022',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
],
station: {
facilitYNum: '668',
visNNum: '20',
facilitYDesc: 'VAMC SPOKANE (668)',
cyclENum: '003',
remiTToFlag: 'L',
maiLInsertFlag: '0',
staTAddress1: '4815 N ASSEMBLY ST',
staTAddress2: null,
staTAddress3: null,
city: 'SPOKANE',
state: 'WA',
ziPCde: '992056185',
ziPCdeOutput: '99205-6185',
baRCde: '*992056185159*',
teLNumFlag: 'P',
teLNum: '1-866-290-4618',
teLNum2: null,
contacTInfo: null,
dM2TelNum: null,
contacTInfo2: null,
toPTelNum: null,
lbXFedexAddress1: null,
lbXFedexAddress2: null,
lbXFedexAddress3: null,
lbXFedexCity: null,
lbXFedexState: null,
lbXFedexZipCde: null,
lbXFedexBarCde: null,
lbXFedexContact: null,
lbXFedexContactTelNum: null,
},
},
],
};
const user81Copays = {
data: [
{
id: 'f4385298-08a6-42f8-a86f-50e97033fb85',
pSSeqNum: 506,
pSTotSeqNum: 588,
pSFacilityNum: '534',
pSFacPhoneNum: null,
pSTotStatement: 27,
pSStatementVal: '0000018255H',
pSStatementDate: '11152021',
pSStatementDateOutput: '11/15/2021',
pSProcessDate: '11112019',
pSProcessDateOutput: '11/11/2019',
pHPatientLstNme: 'JONES',
pHPatientFstNme: 'TRAVIS',
pHPatientMidNme: 'D',
pHAddress1: '1885 SHORE DR S APT 327',
pHAddress2: null,
pHAddress3: null,
pHCity: 'SAVANNAH',
pHState: 'FL',
pHZipCde: '314104413',
pHZipCdeOutput: '31410-4413',
pHCtryNme: null,
pHAmtDue: 15,
pHAmtDueOutput: '15.00 ',
pHPrevBal: 135,
pHPrevBalOutput: '135.00 ',
pHTotCharges: 15,
pHTotChargesOutput: '15.00 ',
pHTotCredits: -135,
pHTotCreditsOutput: '135.00- ',
pHNewBalance: 15,
pHNewBalanceOutput: '15.00 ',
pHSpecialNotes:
'To pay your statement online, go to www.pay.gov or call 1-888-827-4817.',
pHroParaCdes: '304050556065708085',
pHNumOfLines: 10,
pHDfnNumber: 346310,
pHCernerStatementNumber: 1005154223,
pHCernerPatientId: '1005154223',
pHCernerAccountNumber: '5341001005154223',
pHIcnNumber: '1012845638V677813',
pHAccountNumber: 0,
pHLargeFontIndcator: 0,
details: [
{
pDDatePosted: '10072019',
pDDatePostedOutput: '10/07/2019',
pDTransDesc: 'OUTPATIENT CARE(NSC)',
pDTransDescOutput: 'OUTPATIENT CARE',
pDTransAmt: -15,
pDTransAmtOutput: '15.00- ',
pDRefNo: '534-K90HEWN',
},
{
pDDatePosted: '10072019',
pDDatePostedOutput: '10/07/2019',
pDTransDesc: 'OUTPATIENT CARE(NSC)',
pDTransDescOutput: 'OUTPATIENT CARE',
pDTransAmt: -15,
pDTransAmtOutput: '15.00- ',
pDRefNo: '534-K90HEWN',
},
{
pDDatePosted: '10072019',
pDDatePostedOutput: '10/07/2019',
pDTransDesc: 'OUTPATIENT CARE(NSC)',
pDTransDescOutput: 'OUTPATIENT CARE',
pDTransAmt: -15,
pDTransAmtOutput: '15.00- ',
pDRefNo: '534-K90HEWN',
},
{
pDDatePosted: '10072019',
pDDatePostedOutput: '10/07/2019',
pDTransDesc: 'OUTPATIENT CARE(NSC)',
pDTransDescOutput: 'OUTPATIENT CARE',
pDTransAmt: -15,
pDTransAmtOutput: '15.00- ',
pDRefNo: '534-K90HEWN',
},
{
pDDatePosted: '10072019',
pDDatePostedOutput: '10/07/2019',
pDTransDesc: 'OUTPATIENT CARE(NSC)',
pDTransDescOutput: 'OUTPATIENT CARE',
pDTransAmt: -15,
pDTransAmtOutput: '15.00- ',
pDRefNo: '534-K90HEWN',
},
{
pDDatePosted: '10072019',
pDDatePostedOutput: '10/07/2019',
pDTransDesc: 'OUTPATIENT CARE(NSC)',
pDTransDescOutput: 'OUTPATIENT CARE',
pDTransAmt: -15,
pDTransAmtOutput: '15.00- ',
pDRefNo: '534-K90HEWN',
},
{
pDDatePosted: '10072019',
pDDatePostedOutput: '10/07/2019',
pDTransDesc: 'OUTPATIENT CARE(NSC)',
pDTransDescOutput: 'OUTPATIENT CARE',
pDTransAmt: -15,
pDTransAmtOutput: '15.00- ',
pDRefNo: '534-K90HEWN',
},
{
pDDatePosted: '10072019',
pDDatePostedOutput: '10/07/2019',
pDTransDesc: 'OUTPATIENT CARE(NSC)',
pDTransDescOutput: 'OUTPATIENT CARE',
pDTransAmt: -15,
pDTransAmtOutput: '15.00- ',
pDRefNo: '534-K90HEWN',
},
{
pDDatePosted: '10072019',
pDDatePostedOutput: '10/07/2019',
pDTransDesc: 'OUTPATIENT CARE(NSC)',
pDTransDescOutput: 'OUTPATIENT CARE',
pDTransAmt: -15,
pDTransAmtOutput: '15.00- ',
pDRefNo: '534-K90HEWN',
},
{
pDDatePosted: '10152019',
pDDatePostedOutput: '10/15/2019',
pDTransDesc: 'OUTPATIENT CARE(NSC) VISIT DATE: 09/07/2018',
pDTransDescOutput: 'OUTPATIENT CARE VISIT DATE: 09/07/2018',
pDTransAmt: 15,
pDTransAmtOutput: '15.00 ',
pDRefNo: '534-K009FK8',
},
],
station: {
facilitYNum: '534',
visNNum: '07',
facilitYDesc: 'RALPH H. JOHNSON VA MEDICAL CENTER (534)',
cyclENum: '012',
remiTToFlag: 'L',
maiLInsertFlag: '0',
staTAddress1: 'ACCOUNTS RECEIVABLE (04AR)',
staTAddress2: '109 BEE ST',
staTAddress3: null,
city: 'CHARLESTON',
state: 'SC',
ziPCde: '294015703',
ziPCdeOutput: '29401-5703',
baRCde: '*294015703090*',
teLNumFlag: 'P',
teLNum: '1-866-258-2772',
teLNum2: null,
contacTInfo: null,
dM2TelNum: null,
contacTInfo2: null,
toPTelNum: null,
lbXFedexAddress1: null,
lbXFedexAddress2: null,
lbXFedexAddress3: null,
lbXFedexCity: null,
lbXFedexState: null,
lbXFedexZipCde: null,
lbXFedexBarCde: null,
lbXFedexContact: null,
lbXFedexContactTelNum: null,
},
},
{
id: 'c9b1b3ed-8515-4c49-81a9-4f63ae6b29e5',
pSSeqNum: 4,
pSTotSeqNum: 13,
pSFacilityNum: '668',
pSFacPhoneNum: '(509)434-7000',
pSTotStatement: 61,
pSStatementVal: '0000029500{',
pSStatementDate: '04042022',
pSStatementDateOutput: '04/04/2022',
pSProcessDate: '04022022',
pSProcessDateOutput: '04/02/2022',
pHPatientLstNme: 'BROWN',
pHPatientFstNme: 'ANNALISA',
pHPatientMidNme: 'JANET',
pHAddress1: '3160 SOUTH SHADES CT',
pHAddress2: null,
pHAddress3: null,
pHCity: 'SANDPOINT',
pHState: 'ID',
pHZipCde: '838645017',
pHZipCdeOutput: '83864-5017',
pHCtryNme: 'US',
pHAmtDue: 15,
pHAmtDueOutput: '15.00 ',
pHPrevBal: 0,
pHPrevBalOutput: '.00 ',
pHTotCharges: 15,
pHTotChargesOutput: '15.00 ',
pHTotCredits: 0,
pHTotCreditsOutput: '.00 ',
pHNewBalance: 15,
pHNewBalanceOutput: '15.00 ',
pHSpecialNotes: null,
pHroParaCdes: null,
pHNumOfLines: 3,
pHDfnNumber: 0,
pHCernerStatementNumber: 500000000004425,
pHCernerPatientId: '1005154223',
pHCernerAccountNumber: '6681001005154223',
pHIcnNumber: '039219581V969512 ',
pHAccountNumber: 0,
pHLargeFontIndcator: 0,
details: [
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'Outpatient-Family Medicine',
pDTransDescOutput: 'Outpatient-Family Medicine',
pDTransAmt: 15,
pDTransAmtOutput: '15.00 ',
pDRefNo: '17604638',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: '668QD Sandpoint ID VA Clinic',
pDTransDescOutput: ' 668QD Sandpoint ID VA Clinic',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'VISIT_DT 10/12/2021',
pDTransDescOutput: ' VISIT_DT 10/12/2021',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
],
station: {
facilitYNum: '668',
visNNum: '20',
facilitYDesc: 'VAMC SPOKANE (668)',
cyclENum: '003',
remiTToFlag: 'L',
maiLInsertFlag: '0',
staTAddress1: '4815 N ASSEMBLY ST',
staTAddress2: null,
staTAddress3: null,
city: 'SPOKANE',
state: 'WA',
ziPCde: '992056185',
ziPCdeOutput: '99205-6185',
baRCde: '*992056185159*',
teLNumFlag: 'P',
teLNum: '1-866-290-4618',
teLNum2: null,
contacTInfo: null,
dM2TelNum: null,
contacTInfo2: null,
toPTelNum: null,
lbXFedexAddress1: null,
lbXFedexAddress2: null,
lbXFedexAddress3: null,
lbXFedexCity: null,
lbXFedexState: null,
lbXFedexZipCde: null,
lbXFedexBarCde: null,
lbXFedexContact: null,
lbXFedexContactTelNum: null,
},
},
{
id: 'b381cc7b-ea3a-49dc-a982-7146416ed373',
pSSeqNum: 1162,
pSTotSeqNum: 1,
pSFacilityNum: '757',
pSFacPhoneNum: null,
pSTotStatement: 11,
pSStatementVal: '0000040520F',
pSStatementDate: '11052021',
pSStatementDateOutput: '11/05/2021',
pSProcessDate: '06092021',
pSProcessDateOutput: '06/09/2021',
pHPatientLstNme: 'JONES',
pHPatientFstNme: 'TRAVIS',
pHPatientMidNme: 'D',
pHAddress1: '1885 SHORE DR S APT 327',
pHAddress2: null,
pHAddress3: null,
pHCity: 'SOUTH PASADENA',
pHState: 'FL',
pHZipCde: '337074743',
pHZipCdeOutput: '33707-4743',
pHCtryNme: 'US',
pHAmtDue: 46,
pHAmtDueOutput: '46.00 ',
pHPrevBal: 30,
pHPrevBalOutput: '30.00 ',
pHTotCharges: 46,
pHTotChargesOutput: '46.00 ',
pHTotCredits: -30,
pHTotCreditsOutput: '30.00- ',
pHNewBalance: 46,
pHNewBalanceOutput: '46.00 ',
pHSpecialNotes: null,
pHroParaCdes: '254050556065708085',
pHNumOfLines: 7,
pHDfnNumber: 0,
pHCernerStatementNumber: 1005154223,
pHCernerPatientId: '1005154223',
pHCernerAccountNumber: '7571001005154223',
pHIcnNumber: '1012845638V677813',
pHAccountNumber: 0,
pHLargeFontIndcator: 0,
details: [
{
pDDatePosted: '03092020',
pDDatePostedOutput: '03/09/2020',
pDTransDesc: 'OUTPATIENT CARE(NSC) VISIT DATE: 01/14/2020',
pDTransDescOutput: 'OUTPATIENT CARE VISIT DATE: 01/14/2020',
pDTransAmt: 15,
pDTransAmtOutput: '15.00 ',
pDRefNo: '516-K00R4FL',
},
{
pDDatePosted: '03092020',
pDDatePostedOutput: '03/09/2020',
pDTransDesc: 'OUTPATIENT CARE(NSC)',
pDTransDescOutput: 'OUTPATIENT CARE',
pDTransAmt: -15,
pDTransAmtOutput: '15.00- ',
pDRefNo: '516-K00R4FL',
},
{
pDDatePosted: '03242020',
pDDatePostedOutput: '03/24/2020',
pDTransDesc: 'COPAY RX:100020337B FD:01/23/2020',
pDTransDescOutput: 'COPAY RX#100020337B FILL DATE: 01/23/2020',
pDTransAmt: 5,
pDTransAmtOutput: '5.00 ',
pDRefNo: '516-K00RSNZ',
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{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'DRUG:LISINOPRIL 5MG TAB DAYS:30 QTY:30',
pDTransDescOutput:
' DRUG:LISINOPRIL 5MG TAB DAYS:30 QTY:30',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'PHY:SANTOS,LOUISE CHG:$5.00',
pDTransDescOutput: ' PHY:SANTOS,LOUISE CHG:$5.00',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
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{
pDDatePosted: '03242020',
pDDatePostedOutput: '03/24/2020',
pDTransDesc: 'RX CO-PAYMENT/NSC VET',
pDTransDescOutput: 'PAYMENT POSTED ON 03/24/2020',
pDTransAmt: -5,
pDTransAmtOutput: '5.00- ',
pDRefNo: '516-K00RSNZ',
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{
pDDatePosted: '04032020',
pDDatePostedOutput: '04/03/2020',
pDTransDesc: 'COPAY RX:100030241 FD:03/30/2020',
pDTransDescOutput: 'COPAY RX#100030241 FILL DATE: 03/30/2020',
pDTransAmt: 15,
pDTransAmtOutput: '15.00 ',
pDRefNo: '516-K00S829',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'DRUG:ATENOLOL 25MG TAB DAYS:90 QTY:90',
pDTransDescOutput:
' DRUG:ATENOLOL 25MG TAB DAYS:90 QTY:90',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'PHY:GUTHRIE,BROOKE L CHG:$15.00',
pDTransDescOutput:
' PHY:GUTHRIE,BROOKE L CHG:$15.00',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: '04272020',
pDDatePostedOutput: '04/27/2020',
pDTransDesc: 'COPAY RX:100020336 FD:04/23/2020',
pDTransDescOutput: 'COPAY RX#100020336 FILL DATE: 04/23/2020',
pDTransAmt: 15,
pDTransAmtOutput: '15.00 ',
pDRefNo: '516-K00SZBK',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'DRUG:AMLODIPINE BESYLATE 10MG TAB DAYS:90',
pDTransDescOutput:
' DRUG:AMLODIPINE BESYLATE 10MG TAB DAYS:90',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'QTY:90 PHY:GUTHRIE,BROOKE L CHG:$15.00',
pDTransDescOutput:
' QTY:90 PHY:GUTHRIE,BROOKE L CHG:$15.00',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: '04282020',
pDDatePostedOutput: '04/28/2020',
pDTransDesc: 'COPAY RX:100011847 FD:04/23/2020',
pDTransDescOutput: 'COPAY RX#100011847 FILL DATE: 04/23/2020',
pDTransAmt: 8,
pDTransAmtOutput: '8.00 ',
pDRefNo: '516-K00SZBK',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'DRUG:MICONAZOLE NITRATE 2% TOP TINCTURE DAYS:30',
pDTransDescOutput:
' DRUG:MICONAZOLE NITRATE 2% TOP TINCTURE DAYS:30',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
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{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'QTY:60 PHY:GUTHRIE,BROOKE L CHG:$8.00',
pDTransDescOutput:
' QTY:60 PHY:GUTHRIE,BROOKE L CHG:$8.00',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: '05262020',
pDDatePostedOutput: '05/26/2020',
pDTransDesc: 'OUTPATIENT CARE(NSC) VISIT DATE: 04/15/2020',
pDTransDescOutput: 'OUTPATIENT CARE VISIT DATE: 04/15/2020',
pDTransAmt: 50,
pDTransAmtOutput: '50.00 ',
pDRefNo: '516-K00TXGK',
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{
pDDatePosted: '05262020',
pDDatePostedOutput: '05/26/2020',
pDTransDesc: 'OUTPATIENT CARE(NSC)',
pDTransDescOutput: 'OUTPATIENT CARE',
pDTransAmt: -50,
pDTransAmtOutput: '50.00- ',
pDRefNo: '516-K00TXGK',
},
{
pDDatePosted: '06302020',
pDDatePostedOutput: '06/30/2020',
pDTransDesc: 'COPAY RX:100030241 FD:06/30/2020',
pDTransDescOutput: 'COPAY RX#100030241 FILL DATE: 06/30/2020',
pDTransAmt: 15,
pDTransAmtOutput: '15.00 ',
pDRefNo: '516-K00UY3W',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'DRUG:ATENOLOL 25MG TAB DAYS:90 QTY:90',
pDTransDescOutput:
' DRUG:ATENOLOL 25MG TAB DAYS:90 QTY:90',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'PHY:GUTHRIE,BROOKE L CHG:$15.00',
pDTransDescOutput:
' PHY:GUTHRIE,BROOKE L CHG:$15.00',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: '07092020',
pDDatePostedOutput: '07/09/2020',
pDTransDesc: 'OUTPATIENT CARE(NSC) VISIT DATE: 06/08/2020',
pDTransDescOutput: 'OUTPATIENT CARE VISIT DATE: 06/08/2020',
pDTransAmt: 50,
pDTransAmtOutput: '50.00 ',
pDRefNo: '516-K00V8T8',
},
{
pDDatePosted: '07092020',
pDDatePostedOutput: '07/09/2020',
pDTransDesc: 'OUTPATIENT CARE(NSC)',
pDTransDescOutput: 'OUTPATIENT CARE',
pDTransAmt: -50,
pDTransAmtOutput: '50.00- ',
pDRefNo: '516-K00V8T8',
},
{
pDDatePosted: '07092020',
pDDatePostedOutput: '07/09/2020',
pDTransDesc: 'COMMENT: K00ULWR PD $50.00 DOS 060820',
pDTransDescOutput:
' COMMENT: K00ULWR PD $50.00 DOS 060820',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: '516-K00V8T8',
},
{
pDDatePosted: '08132020',
pDDatePostedOutput: '08/13/2020',
pDTransDesc: 'COPAY RX:100020336 FD:08/11/2020',
pDTransDescOutput: 'COPAY RX#100020336 FILL DATE: 08/11/2020',
pDTransAmt: 15,
pDTransAmtOutput: '15.00 ',
pDRefNo: '516-K00WDZQ',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'DRUG:AMLODIPINE BESYLATE 10MG TAB DAYS:90',
pDTransDescOutput:
' DRUG:AMLODIPINE BESYLATE 10MG TAB DAYS:90',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'QTY:90 PHY:GUTHRIE,BROOKE L CHG:$15.00',
pDTransDescOutput:
' QTY:90 PHY:GUTHRIE,BROOKE L CHG:$15.00',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: '09222020',
pDDatePostedOutput: '09/22/2020',
pDTransDesc: 'OUTPATIENT CARE(NSC) VISIT DATE: 08/20/2020',
pDTransDescOutput: 'OUTPATIENT CARE VISIT DATE: 08/20/2020',
pDTransAmt: 50,
pDTransAmtOutput: '50.00 ',
pDRefNo: '516-K00XUY2',
},
{
pDDatePosted: '09222020',
pDDatePostedOutput: '09/22/2020',
pDTransDesc: 'OUTPATIENT CARE(NSC)',
pDTransDescOutput: 'OUTPATIENT CARE',
pDTransAmt: -50,
pDTransAmtOutput: '50.00- ',
pDRefNo: '516-K00XUY2',
},
{
pDDatePosted: '09222020',
pDDatePostedOutput: '09/22/2020',
pDTransDesc: 'COMMENT: K00X41A PD $50.00 DOS 082020',
pDTransDescOutput:
' COMMENT: K00X41A PD $50.00 DOS 082020',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: '516-K00XUY2',
},
{
pDDatePosted: '10072020',
pDDatePostedOutput: '10/07/2020',
pDTransDesc: 'COPAY RX:100030241 FD:10/05/2020',
pDTransDescOutput: 'COPAY RX#100030241 FILL DATE: 10/05/2020',
pDTransAmt: 15,
pDTransAmtOutput: '15.00 ',
pDRefNo: '516-K10J56V',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'DRUG:ATENOLOL 25MG TAB DAYS:90 QTY:90',
pDTransDescOutput:
' DRUG:ATENOLOL 25MG TAB DAYS:90 QTY:90',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'PHY:GUTHRIE,BROOKE L CHG:$15.00',
pDTransDescOutput:
' PHY:GUTHRIE,BROOKE L CHG:$15.00',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
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{
pDDatePosted: '10292020',
pDDatePostedOutput: '10/29/2020',
pDTransDesc: 'COPAY RX:100045030 FD:10/27/2020',
pDTransDescOutput: 'COPAY RX#100045030 FILL DATE: 10/27/2020',
pDTransAmt: 24,
pDTransAmtOutput: '24.00 ',
pDRefNo: '516-K10J56V',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'DRUG:NIACIN (SLO-NIACIN) 250MG TAB,SA DAYS:90',
pDTransDescOutput:
' DRUG:NIACIN (SLO-NIACIN) 250MG TAB,SA DAYS:90',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'QTY:90 PHY:VELAZQUEZ SANCHEZ,VANESSA',
pDTransDescOutput:
' QTY:90 PHY:VELAZQUEZ SANCHEZ,VANESSA',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'CHG:$24.00',
pDTransDescOutput: ' CHG:$24.00',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: '10292020',
pDDatePostedOutput: '10/29/2020',
pDTransDesc: 'COPAY RX:100045028 FD:10/27/2020',
pDTransDescOutput: 'COPAY RX#100045028 FILL DATE: 10/27/2020',
pDTransAmt: 8,
pDTransAmtOutput: '8.00 ',
pDRefNo: '516-K10J56V',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'DRUG:CARBAMIDE PEROXIDE 6.5% OTIC SOLN DAYS:14',
pDTransDescOutput:
' DRUG:CARBAMIDE PEROXIDE 6.5% OTIC SOLN DAYS:14',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'QTY:45 PHY:VELAZQUEZ SANCHEZ,VANESSA CHG:$8.00',
pDTransDescOutput:
' QTY:45 PHY:VELAZQUEZ SANCHEZ,VANESSA CHG:$8.00',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: '10292020',
pDDatePostedOutput: '10/29/2020',
pDTransDesc: 'COPAY RX:100045029 FD:10/27/2020',
pDTransDescOutput: 'COPAY RX#100045029 FILL DATE: 10/27/2020',
pDTransAmt: 8,
pDTransAmtOutput: '8.00 ',
pDRefNo: '516-K10J56V',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'DRUG:MICONAZOLE NITRATE 2% TOP TINCTURE DAYS:30',
pDTransDescOutput:
' DRUG:MICONAZOLE NITRATE 2% TOP TINCTURE DAYS:30',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'QTY:90 PHY:VELAZQUEZ SANCHEZ,VANESSA CHG:$8.00',
pDTransDescOutput:
' QTY:90 PHY:VELAZQUEZ SANCHEZ,VANESSA CHG:$8.00',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: '11192020',
pDDatePostedOutput: '11/19/2020',
pDTransDesc: 'PAYMENT (Int:0.12 Adm:1.64)',
pDTransDescOutput: 'PAYMENT POSTED ON 11/19/2020',
pDTransAmt: -16.76,
pDTransAmtOutput: '16.76- ',
pDRefNo: '516-K00JZPJ',
},
{
pDDatePosted: '11192020',
pDDatePostedOutput: '11/19/2020',
pDTransDesc: 'PAYMENT (Int:0.26 Adm:0.00)',
pDTransDescOutput: 'PAYMENT POSTED ON 11/19/2020',
pDTransAmt: -15.26,
pDTransAmtOutput: '15.26- ',
pDRefNo: '516-K00N8XA',
},
{
pDDatePosted: '11192020',
pDDatePostedOutput: '11/19/2020',
pDTransDesc: 'PAYMENT',
pDTransDescOutput: 'PAYMENT POSTED ON 11/19/2020',
pDTransAmt: -15,
pDTransAmtOutput: '15.00- ',
pDRefNo: '516-K00QKJJ',
},
{
pDDatePosted: '11192020',
pDDatePostedOutput: '11/19/2020',
pDTransDesc: 'PAYMENT',
pDTransDescOutput: 'PAYMENT POSTED ON 11/19/2020',
pDTransAmt: -15,
pDTransAmtOutput: '15.00- ',
pDRefNo: '516-K00S829',
},
{
pDDatePosted: '11192020',
pDDatePostedOutput: '11/19/2020',
pDTransDesc: 'PAYMENT',
pDTransDescOutput: 'PAYMENT POSTED ON 11/19/2020',
pDTransAmt: -23,
pDTransAmtOutput: '23.00- ',
pDRefNo: '516-K00SZBK',
},
{
pDDatePosted: '11192020',
pDDatePostedOutput: '11/19/2020',
pDTransDesc: 'PAYMENT',
pDTransDescOutput: 'PAYMENT POSTED ON 11/19/2020',
pDTransAmt: -15,
pDTransAmtOutput: '15.00- ',
pDRefNo: '516-K00UY3W',
},
{
pDDatePosted: '11192020',
pDDatePostedOutput: '11/19/2020',
pDTransDesc: 'PAYMENT',
pDTransDescOutput: 'PAYMENT POSTED ON 11/19/2020',
pDTransAmt: -15,
pDTransAmtOutput: '15.00- ',
pDRefNo: '516-K00WDZQ',
},
{
pDDatePosted: '11192020',
pDDatePostedOutput: '11/19/2020',
pDTransDesc: 'PAYMENT',
pDTransDescOutput: 'PAYMENT POSTED ON 11/19/2020',
pDTransAmt: -55,
pDTransAmtOutput: '55.00- ',
pDRefNo: '516-K10J56V',
},
{
pDDatePosted: '11232020',
pDDatePostedOutput: '11/23/2020',
pDTransDesc: 'OUTPATIENT CARE(NSC) VISIT DATE: 10/27/2020',
pDTransDescOutput: 'OUTPATIENT CARE VISIT DATE: 10/27/2020',
pDTransAmt: 15,
pDTransAmtOutput: '15.00 ',
pDRefNo: '516-K10LD3I',
},
{
pDDatePosted: '11232020',
pDDatePostedOutput: '11/23/2020',
pDTransDesc: 'OUTPATIENT CARE(NSC)',
pDTransDescOutput: 'OUTPATIENT CARE',
pDTransAmt: -15,
pDTransAmtOutput: '15.00- ',
pDRefNo: '516-K10LD3I',
},
{
pDDatePosted: '11232020',
pDDatePostedOutput: '11/23/2020',
pDTransDesc: 'COMMENT: K10KM1P PD $15.00 DOS:10/27/20',
pDTransDescOutput:
' COMMENT: K10KM1P PD $15.00 DOS:10/27/20',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: '516-K10LD3I',
},
{
pDDatePosted: '12012020',
pDDatePostedOutput: '12/01/2020',
pDTransDesc: 'COPAY RX:100046632 FD:11/18/2020',
pDTransDescOutput: 'COPAY RX#100046632 FILL DATE: 11/18/2020',
pDTransAmt: 15,
pDTransAmtOutput: '15.00 ',
pDRefNo: '516-K10LT59',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'DRUG:AMLODIPINE BESYLATE 10MG TAB DAYS:90',
pDTransDescOutput:
' DRUG:AMLODIPINE BESYLATE 10MG TAB DAYS:90',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'QTY:90 PHY:VELAZQUEZ SANCHEZ,VANESSA',
pDTransDescOutput:
' QTY:90 PHY:VELAZQUEZ SANCHEZ,VANESSA',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'CHG:$15.00',
pDTransDescOutput: ' CHG:$15.00',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: '12162020',
pDDatePostedOutput: '12/16/2020',
pDTransDesc: 'COPAY RX:100030241A FD:12/12/2020',
pDTransDescOutput: 'COPAY RX#100030241A FILL DATE: 12/12/2020',
pDTransAmt: 15,
pDTransAmtOutput: '15.00 ',
pDRefNo: '516-K10MUDV',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'DRUG:ATENOLOL 25MG TAB DAYS:90 QTY:90',
pDTransDescOutput:
' DRUG:ATENOLOL 25MG TAB DAYS:90 QTY:90',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'PHY:VELAZQUEZ SANCHEZ,VANESSA CHG:$15.00',
pDTransDescOutput:
' PHY:VELAZQUEZ SANCHEZ,VANESSA CHG:$15.00',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: '12212020',
pDDatePostedOutput: '12/21/2020',
pDTransDesc: 'OUTPATIENT CARE(NSC) VISIT DATE: 11/13/2020',
pDTransDescOutput: 'OUTPATIENT CARE VISIT DATE: 11/13/2020',
pDTransAmt: 15,
pDTransAmtOutput: '15.00 ',
pDRefNo: '516-K10N4AR',
},
{
pDDatePosted: '12212020',
pDDatePostedOutput: '12/21/2020',
pDTransDesc: 'OUTPATIENT CARE(NSC)',
pDTransDescOutput: 'OUTPATIENT CARE',
pDTransAmt: -15,
pDTransAmtOutput: '15.00- ',
pDRefNo: '516-K10N4AR',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'INTEREST/ADM. CHARGE (Int:0.32 Adm:1.64 Other:0.00',
pDTransDescOutput:
'INTEREST/ADM. CHARGE (Int:0.32 Adm:1.64 Other:0.00',
pDTransAmt: 1.96,
pDTransAmtOutput: '1.96 ',
pDRefNo: null,
},
],
station: {
facilitYNum: '649',
visNNum: '22',
facilitYDesc: 'PRESCOTT VA MEDICAL CENTER (649)',
cyclENum: '016',
remiTToFlag: 'L',
maiLInsertFlag: '0',
staTAddress1: '500 N US HIGHWAY 89',
staTAddress2: 'AGENT CASHIER (04C)',
staTAddress3: null,
city: 'PRESCOTT',
state: 'AZ',
ziPCde: '863135001',
ziPCdeOutput: '86313-5001',
baRCde: '*863135001003*',
teLNumFlag: 'S',
teLNum: '1-866-802-6819',
teLNum2: null,
contacTInfo: null,
dM2TelNum: null,
contacTInfo2: null,
toPTelNum: null,
lbXFedexAddress1: null,
lbXFedexAddress2: null,
lbXFedexAddress3: null,
lbXFedexCity: null,
lbXFedexState: null,
lbXFedexZipCde: null,
lbXFedexBarCde: null,
lbXFedexContact: null,
lbXFedexContactTelNum: null,
},
},
{
id: '8ce19ada-8bc1-4c35-ab5a-0f34c78c10d9',
pSSeqNum: 8,
pSTotSeqNum: 31,
pSFacilityNum: '668',
pSFacPhoneNum: '(509)434-7000',
pSTotStatement: 40,
pSStatementVal: '0000024882{',
pSStatementDate: '05042022',
pSStatementDateOutput: '05/04/2022',
pSProcessDate: '05042022',
pSProcessDateOutput: '05/04/2022',
pHPatientLstNme: 'BROWN',
pHPatientFstNme: 'JANET',
pHPatientMidNme: null,
pHAddress1: '5150 S LAKIN DR',
pHAddress2: null,
pHAddress3: null,
pHCity: 'SPOKANE VALLEY',
pHState: 'WA',
pHZipCde: '992160645',
pHZipCdeOutput: '99216-0645',
pHCtryNme: 'US',
pHAmtDue: 110.45,
pHAmtDueOutput: '110.45 ',
pHPrevBal: 45,
pHPrevBalOutput: '45.00 ',
pHTotCharges: 65.45,
pHTotChargesOutput: '65.45 ',
pHTotCredits: 0,
pHTotCreditsOutput: '.00 ',
pHNewBalance: 110.45,
pHNewBalanceOutput: '110.45 ',
pHSpecialNotes: null,
pHroParaCdes: null,
pHNumOfLines: 18,
pHDfnNumber: 0,
pHCernerStatementNumber: 500000000006971,
pHCernerPatientId: '1005154223',
pHCernerAccountNumber: '6681001005154223',
pHIcnNumber: '1003388516V511164',
pHAccountNumber: 0,
pHLargeFontIndcator: 0,
details: [
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'Outpatient-Family Medicine(BAL FWD)',
pDTransDescOutput: 'Outpatient-Family Medicine(BAL FWD)',
pDTransAmt: 15,
pDTransAmtOutput: '15.00 ',
pDRefNo: '21709831',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: '668 Mann-Grandstaff WA VA Medical Center',
pDTransDescOutput:
' 668 Mann-Grandstaff WA VA Medical Center',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'VISIT_DT 01/19/2022',
pDTransDescOutput: ' VISIT_DT 01/19/2022',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: '01/19/2022 Interest Fee for Self-Pay Overdue Balan',
pDTransDescOutput:
'01/19/2022 Interest Fee for Self-Pay Overdue Balan',
pDTransAmt: 0.15,
pDTransAmtOutput: '0.15 ',
pDRefNo: '21709831',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'Outpatient-Behavioral Health(BAL FWD)',
pDTransDescOutput: 'Outpatient-Behavioral Health(BAL FWD)',
pDTransAmt: 15,
pDTransAmtOutput: '15.00 ',
pDRefNo: '22935355',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: '668 Mann-Grandstaff WA VA Medical Center',
pDTransDescOutput:
' 668 Mann-Grandstaff WA VA Medical Center',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'VISIT_DT 02/11/2022',
pDTransDescOutput: ' VISIT_DT 02/11/2022',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: '02/11/2022 Interest Fee for Self-Pay Overdue Balan',
pDTransDescOutput:
'02/11/2022 Interest Fee for Self-Pay Overdue Balan',
pDTransAmt: 0.15,
pDTransAmtOutput: '0.15 ',
pDRefNo: '22935355',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'Outpatient-Behavioral Health(BAL FWD)',
pDTransDescOutput: 'Outpatient-Behavioral Health(BAL FWD)',
pDTransAmt: 15,
pDTransAmtOutput: '15.00 ',
pDRefNo: '24208187',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: '668 Mann-Grandstaff WA VA Medical Center',
pDTransDescOutput:
' 668 Mann-Grandstaff WA VA Medical Center',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'VISIT_DT 03/08/2022',
pDTransDescOutput: ' VISIT_DT 03/08/2022',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: '03/08/2022 Interest Fee for Self-Pay Overdue Balan',
pDTransDescOutput:
'03/08/2022 Interest Fee for Self-Pay Overdue Balan',
pDTransAmt: 0.15,
pDTransAmtOutput: '0.15 ',
pDRefNo: '24208187',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'Outpatient-Behavioral Health',
pDTransDescOutput: 'Outpatient-Behavioral Health',
pDTransAmt: 15,
pDTransAmtOutput: '15.00 ',
pDRefNo: '25891118',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: '668 Mann-Grandstaff WA VA Medical Center',
pDTransDescOutput:
' 668 Mann-Grandstaff WA VA Medical Center',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'VISIT_DT 04/05/2022',
pDTransDescOutput: ' VISIT_DT 04/05/2022',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'Outpatient-Urology',
pDTransDescOutput: 'Outpatient-Urology',
pDTransAmt: 50,
pDTransAmtOutput: '50.00 ',
pDRefNo: '26652313',
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: '668 Mann-Grandstaff WA VA Medical Center',
pDTransDescOutput:
' 668 Mann-Grandstaff WA VA Medical Center',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
{
pDDatePosted: null,
pDDatePostedOutput: '',
pDTransDesc: 'VISIT_DT 04/16/2022',
pDTransDescOutput: ' VISIT_DT 04/16/2022',
pDTransAmt: 0,
pDTransAmtOutput: '.00 ',
pDRefNo: null,
},
],
station: {
facilitYNum: '668',
visNNum: '20',
facilitYDesc: 'VAMC SPOKANE (668)',
cyclENum: '003',
remiTToFlag: 'L',
maiLInsertFlag: '0',
staTAddress1: '4815 N ASSEMBLY ST',
staTAddress2: null,
staTAddress3: null,
city: 'SPOKANE',
state: 'WA',
ziPCde: '992056185',
ziPCdeOutput: '99205-6185',
baRCde: '*992056185159*',
teLNumFlag: 'P',
teLNum: '1-866-290-4618',
teLNum2: null,
contacTInfo: null,
dM2TelNum: null,
contacTInfo2: null,
toPTelNum: null,
lbXFedexAddress1: null,
lbXFedexAddress2: null,
lbXFedexAddress3: null,
lbXFedexCity: null,
lbXFedexState: null,
lbXFedexZipCde: null,
lbXFedexBarCde: null,
lbXFedexContact: null,
lbXFedexContactTelNum: null,
},
},
],
status: 200,
};
module.exports = {
has3Copays,
user81Copays,
};