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@raddrick
Created May 10, 2013 18:25
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rvhs form results
{
"data": {
"general_patient_type": "No",
"general_wsib": "No",
"general_language": "E",
"general_first_name": "Rick",
"general_middle_name": "Roland",
"general_last_name": "Graham",
"general_sex": "M",
"general_dob_day": "3",
"general_dob_month": "7",
"general_dob_year": "1998",
"general_age": null,
"general_marital_status": "S",
"general_address": "200 Somewhere St",
"general_unit": "404",
"general_city": "Ottawa",
"general_province": "ON",
"general_postal_code": "K1S 1B1",
"general_home_phone_area": "613",
"general_home_phone_exchange": "999",
"general_home_phone_line": "9875",
"general_alternative_phone_area": "613",
"general_alternative_phone_exchange": "777",
"general_alternative_phone_line": "4343",
"general_health_card": "6614443338",
"general_version": "TC",
"general_expiry_day": "2",
"general_expiry_month": "2",
"general_expiry_year": "2021",
"general_family_physician": "AARG",
"general_family_physician_name": "",
"general_family_physician_address": "",
"general_family_physician_address2": "",
"general_family_physician_city": "",
"general_family_physician_province": "ON",
"general_family_physician_postal_code": "",
"general_family_physician_phone_area": "",
"general_family_physician_phone_exchange": "",
"general_family_physician_phone_line": "",
"general_complaint": "SURGERY",
"general_appointment_date_day": "5",
"general_appointment_date_month": "6",
"general_appointment_date_year": "2013",
"general_language_choice": "ENGLISH",
"allergy_drug": "Yes",
"allergy_food": "Yes",
"allergy_other": "Yes",
"allergy_moreinfo": "Latex",
"medicalert_diabetes": "Yes",
"medicalert_latex": "Yes",
"medicalert_moreinfo": "something",
"wsib_employment_status": null,
"wsib_claim_number": null,
"wsib_employer": null,
"wsib_phone_area": null,
"wsib_phone_exchange": null,
"wsib_phone_line": null,
"wsib_extension": null,
"wsib_address": null,
"wsib_address2": null,
"wsib_city": null,
"wsib_province": null,
"wsib_postal_code": null,
"wsib_occupation": null,
"wsib_lastworked_day": null,
"wsib_lastworked_month": null,
"wsib_lastworked_year": null,
"wsib_sin": null,
"inpatient_maternity": "No",
"inpatient_inpatient": "No",
"inpatient_denomination": "No",
"inpatient_denomination_type": null,
"inpatient_spiritual_care": "No",
"inpatient_accomodations": null,
"insurance_insurance_plan": null,
"insurance_policy_number": null,
"insurance_certificate": null,
"insurance_group_name": null,
"insurance_division_number": null,
"insurance_policy_holder_first_name": null,
"insurance_policy_holder_last_name": null,
"insurance_sex": null,
"insurance_policy_holder_relation": null,
"insurance_policy_holder_employer": null,
"insurance_policy_holder_employer_name": null,
"insurance_policy_holder_employer_address": null,
"insurance_policy_holder_employer_address2": null,
"insurance_policy_holder_employer_city": null,
"insurance_policy_holder_employer_province": null,
"insurance_policy_holder_employer_postal_code": null,
"guarantor_rel": "B",
"guarantor_first_name": "Nick",
"guarantor_last_name": "Mujica",
"guarantor_sex": "F",
"guarantor_dob_day": "3",
"guarantor_dob_month": "4",
"guarantor_dob_year": "1990",
"guarantor_marital_status": "D",
"guarantor_address": "303 Roland Ave",
"guarantor_address2": "#200",
"guarantor_city": "Ottawa",
"guarantor_province": "ON",
"guarantor_postal": "M3J1V3",
"guarantor_phone_area": "613",
"guarantor_phone_exchange": "777",
"guarantor_phone_line": "8888",
"guarantor_messages": "ME",
"relative_rel": "F",
"relative_first_name": "Jody",
"relative_last_name": "Cassidy",
"relative_phone_area": "613",
"relative_phone_exchange": "666",
"relative_phone_line": "7777",
"relative_work_phone_area": "999",
"relative_work_phone_exchange": "888",
"relative_work_phone_line": "7777",
"relative_extension": "202",
"updated_at": "2013-05-06 04:05:19"
},
"status": "success",
"transcript": ""
}
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