{
"id": 123456789, // int. read-only
"practice_id": 65540, // int. required
// patient summary
"patient_id": 789012, // int. required
"patient_first_name": "John", // string(70). required
"patient_last_name": "Doe", // string(70). required
"patient_dob": "1990-05-15", // date. required
// policy details
"status": "active", // enum. required. Values: "active", "inactive"
"rank": 1, // int. optional. nullable
"carrier_id": 70850314606, // int. optional. nullable
"carrier_name": "Medicare", // string(200). optional. nullable
"plan_id": 123456, // int. optional. nullable
"plan_name": "Medicare Part A", // string(200). optional. nullable
"group_id": "GRP123", // string(50). optional. nullable
"member_id": "MEM456789", // string(50). optional. nullable
"copay": "25.00", // string. optional. nullable. decimal format
"deductible": "1500.00", // string. optional. nullable. decimal format
"start_date": "2024-01-01", // date. optional. nullable
"end_date": "2024-12-31", // date. optional. nullable
"phone": "(415) 231-5164", // string(20). optional. nullable
"extension": "123", // string(6). optional. nullable
// Address fields
"address": "550 15th St.", // string(200). optional. nullable
"suite": "Suite #21", // string(40). optional. nullable
"city": "San Francisco", // string(50). optional. nullable
"state": "CA", // string(2). optional. nullable
"zip": "94103", // string(10). optional. nullable
"county_code": "075", // string(10). optional. nullable
// insured person details
"insured_person_first_name": "Jane", // string(200). optional. nullable
"insured_person_last_name": "Smith", // string(200). optional. nullable
"insured_person_address": "123 Main St.", // string(200). optional. nullable
"insured_person_city": "Oakland", // string(50). optional. nullable
"insured_person_state": "CA", // string(2). optional. nullable
"insured_person_zip": "94601", // string(10). optional. nullable
"insured_person_id": "INS789", // string(50). optional. nullable
"insured_person_dob": "1985-03-20", // date. optional. nullable
"insured_person_sex_at_birth": "F", // string(1). optional. nullable
"insured_person_ssn": "123-45-6789", // string(11). optional. nullable
"relationship_to_insured": "self", // enum. optional. default: "self"
// other details
"payment_program": "medicare_part_b", // enum. optional. nullable. Values: "medicare_part_b", "medicare_advantage", "medicaid", "commercial_hmsa", "commercial_sfhp", "commercial_other", "workers_compensation"
"medicare_secondary_code": "12", // string(5). optional. nullable
}
