| Name | Description | Type | Additional information |
|---|---|---|---|
| IsMaternityTreatment | boolean |
None. |
|
| DeliveryDate | string |
None. |
|
| IllnessOccurredDate | string |
None. |
|
| ProblemDetails | string |
None. |
|
| DiagnosisDetails | string |
None. |
|
| PreviousDiagnosisDetails | string |
None. |
|
| InjuryAnyWayToPatientsOccupation | boolean |
None. |
|
| InjuryAnyWayToAutomobileAccident | boolean |
None. |
|
| InjuryAnyTypeOfAccident | boolean |
None. |
|
| AccidentDetails | string |
None. |
|
| AutomobileDetails | string |
None. |
|
| CoveredByOtherGroupPlan | boolean |
None. |
|
| CoveredByMedicareOrGovtAgency | boolean |
None. |
|
| CoveredByAutomobileInsurance | boolean |
None. |
|
| OtherSourceDetails | string |
None. |
|
| ProviderName | string |
None. |
|
| ProviderPhoneNumber | string |
None. |
|
| ProviderAddress | string |
None. |
|
| ProviderEmail | string |
None. |
|
| ProviderPostalCode | string |
None. |
|
| ProviderCountry | string |
None. |
|
| RequestId | string |
None. |
|
| AuthenticationId | string |
None. |
|
| Portal | string |
None. |
|
| Individual | string |
None. |
|
| Language | string |
None. |
|
| Oid | string |
None. |
|
| string |
None. |
||
| PhoneNumber | string |
None. |
|
| IsUpdateEmailAndPhone | boolean |
None. |
|
| ClaimName | string |
None. |