{
  "patient": {
    "firstName": "Jane",
    "lastName": "Doe",
    "dateOfBirth": "1985-04-15",
    "gender": "FEMALE",
    "memberId": "ABC123456789"
  },
  "provider": {
    "npi": "1234567890",
    "firstName": "John",
    "lastName": "Smith"
  },
  "payer": {
    "payerId": "00019",
    "payerName": "United Healthcare"
  },
  "encounter": {
    "date_of_service": "2026-06-12",
    "service_type_codes": [
      "30"
    ]
  }
}