QueryResponse

[
  {
    "claim_id": "e4eaaaf2-d142-11e1-b3e4-080027620cdd",
    "claim": {
      "date_of_service_start": "2023-12-10",
      "date_of_service_end": "2023-12-20",
      "plan_id": "1234AB56789",
      "billing_provider_npi": 1457450116,
      "principal_diagnosis": {
        "code": "A40.9",
        "present_on_admission": "Y"
      },
      "secondary_diagnosis": [
        {
          "code": "J18. 9",
          "present_on_admission": "Y"
        }
      ],
      "admitting_diagnosis": {
        "code": "J18. 9",
        "present_on_admission": "Y"
      },
      "procedures": [],
      "discharge_status": 1
    },
    "discharge_summary": {
      "text": "Patient Name: John Doe Patient ID: 123456 Date of Birth: 01/01/1980 Date of Admission: 12/10/2023 Date of Discharge: 12/20/2023 Attending Physician: Dr. Jane Smith\nAdmission Diagnosis:\nPneumonia\nSurgical Procedure: None  Hospital Course: Mr. John Doe, a 40-year-old male, was admitted to the hospital with symptoms of high fever, cough, shortness of breath, and chest pain. Based on clinical examination and chest X-ray findings, he was diagnosed with bacterial pneumonia..."
    },
    "validation": [
      {
        "diagnosis": {
          "code": "A40.9",
          "present_on_admission": "Y"
        },
        "determination": {
          "result": "Unsupported",
          "confidence": 0.88,
          "reasoning": "Diagnosis not supported as the SOFA score threshold was not met when account for baseline creatinine",
          "evidence": [
            {
              "criteria": "Renal Dysfunction",
              "source": {
                "start_index": 1319,
                "end_index": 1362,
                "text": "CKD baseline 1.3 elevated to 2.1 creatinine"
              },
              "evaluation": "Rejects"
            }
          ]
        }
      }
    ]
  }
]