{
  "externalId": "report_demo_001",
  "billingMode": "med_legal",
  "patient": {
    "firstName": "Taylor",
    "lastName": "Example",
    "dateOfBirth": "1984-04-12",
    "address": {
      "line1": "100 Example Avenue",
      "city": "Los Angeles",
      "state": "CA",
      "postalCode": "90012"
    }
  },
  "claim": {
    "claimNumber": "DEMO-12345",
    "employer": "Example Manufacturing",
    "dateOfInjury": "2026-06-20",
    "injuryState": "CA",
    "claimsAdministrator": {
      "id": "REPLACE_WITH_DIRECTORY_ID",
      "name": "REPLACE_WITH_DIRECTORY_NAME"
    }
  },
  "service": {
    "date": "2026-08-25"
  },
  "billingProvider": {
    "name": "Example Evaluations Medical Group, Inc.",
    "taxId": "12-3456789",
    "npi": "1234567893",
    "phone": "213-555-0100",
    "address": {
      "line1": "100 Example Avenue",
      "city": "Los Angeles",
      "state": "CA",
      "postalCode": "90012"
    }
  },
  "renderingProvider": {
    "name": "Avery Example, MD",
    "npi": "1234567893",
    "taxonomy": "208D00000X"
  },
  "serviceLocation": {
    "name": "Main office",
    "address": {
      "line1": "100 Example Avenue",
      "city": "Los Angeles",
      "state": "CA",
      "postalCode": "90012"
    },
    "placeOfServiceCode": "11"
  },
  "diagnoses": [
    "M25.512"
  ],
  "serviceLines": [
    {
      "code": "ML201",
      "units": 1
    }
  ]
}