MedicalHistory

tobaccoUsedstring

Indicator flag for tobacco preferences

Allowed values:YesNoUnknown

USResidentPast2YrsIndstring

Indicator flag for resident options

Allowed values:YesNoUnknown

livingHistoryarray[object]

Show Child Parameters

foreignTravelPlanNext2yrsstring

Indicator flag for foreign travel plans

Allowed values:YesNoUnknown

foreignTravelarray[object]

Show Child Parameters

restrictedTravelPlanNext2yrsstring

Indicator flag for foreign travel plans for 2 years

Allowed values:YesNo

useExistingPolicyFundsstring

Indicator flag for existing policy funds applicability

Allowed values:YesNoUnknown

heightFeetstring

height of party in feet

Example:5

heightInchesstring

height of party in inches

Example:5

weightstring

Weight of party in pounds

Example:150

primaryPhysicianIndstring

Indicator flag for primary physician

Allowed values:YesNoUnknown

disabilityBenefitsIndstring

Indicator flag for disability benefit

Allowed values:YesNoUnknown

disabilityPaymentOptionsstring

Indicator flag for disability benefit

Allowed values:YesNoUnknown

existingPolicyHistoryarray[object]

Show Child Parameters

riskInfoobject

Show Child Parameters

Example

lostWeightRecentlystring

Indicator flag for weight loss

Allowed values:YesNoUnknown

lostWeightReasonarray[string]

lostWeightReason

Allowed values:DietIllnessExerciseOtherSurgeryUnknownPregnancy

lostWeightOtherDescstring

Description value if lostWeightReason is selected as Other

dailyActivityAssistantIndstring

Indicator flag for daily activity assistant required

Allowed values:YesNo

durationTobaccoUsedstring

Duration stating use of tobacco

Example:5

marijuanaUsedIndstring

Indicator flag for marijuana used

Allowed values:YesNoUnknown

durationMarijuanaUsedstring

Duration stating use of Marijuana

Example:5

assistanceRequiredstring

Indicator flag for help needed or not

Allowed values:YesNoUnknown

diagnosticTestIndstring

Indicator flag for diagnostic tests

Allowed values:YesNoUnknown

hospitalizedRecentlyIndstring

Indicator flag for hospitalization history

Allowed values:YesNoUnknown

outstandingTreatmentsstring

Indicator flag for outstanding treatment except AIDS and HIV

Allowed values:YesNoUnknown

treatmentListarray[string]

Allowed values:Allergy TestingRoutine Blood workRoutine Urine testingRoutine Pap smearRoutine colonoscopyRoutine mammogramRoutine EKGImaging for bone or jointRoutine bone densityPregnancy or fertility relatedVision or HearingOther

convictedIndstring

Indicator flag

Allowed values:YesNoUnknown

felonyIndstring

Indicator flag for felony

Allowed values:YesNoUnknown

covid19Indstring

Indicator flag for covid 19 hospitalization

Allowed values:YesNoUnknown

deceasedParentIndstring

Indicator flag for parents

Allowed values:YesNoUnknown

deceaseFamilyarray[object]

Show Child Parameters

rejectionIndstring

Indicator flag for rejection of insurence application

Allowed values:YesNo

medicalHistoryarray[object]

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lifeStyleActivitiesobject

Show Child Parameters

violationsarray[object]

Show Child Parameters

Example

conditionTypestring

Medical condition questions

Allowed values:NoneSubstance AbuseDrug AbuseAlcoholismSelf HelpArthritisAnkylosing SpondylitisMyositisRheumatoid ArthritisSclerodermaSLEGranulomatosisBenign TumorBrain TumorColon PolypsInsitu MelanomaInsitu BreastOvarian CystBlood DisorderAplastic AnemiaClotting DisorderEssential ThrombocytosisHemochromatosisLow PlateletsPolycythemia VeraCancerBreast CancerColon CancerLeukemiaLymphomasLung CancerMelanomaOvarian CancerPancreatic CancerProstate CancerSkin CancerTesticular CancerAlzheimer DiseaseALSCerebral PalsyEpilepsyMultiple SclerosisParaplegiaStrokeEndocrine DisorderAddisons DiseaseCushings DiseaseHyperparathyroidismHyperthyroidismPituitary DisorderThyroid NoduleHypothyroidismLiver DisorderAutoimmune HepatitisBarrett EsophagusChronic PancreatitisLiver CirrhosisCrohns DiseaseHepatitis BHepatitis CLiver EnzymesUlcerative ColitisHeart DisorderAbnormal HeartAneurysmBrain AneurysmThrombosisCoronary DiseaseHeart AttackHeart FailureCardiomyopathyHeart ValveHBPPacemakerKidney DisorderKidney InfectionGlomerulonephritisKidney failurePKDBlood UrineSelf CatheterizationRespiratory DisorderAsthmaCOPDSleep ApneaMens HealthPSAEnlarged ProstateMetabolic DisorderHigh CholesterolDiabetes Type1Diabetes Type2PrediabetesPsychiatric IllnessADHDAnxietyBipolar DisorderDepressionEating DisorderPTSDSchizophreniaUnspecifiedHIVAIDSARCHIVWomens HealthAbnormal MammogramAbnormal PapBrain DisorderCystic FibrosisPulmonary FibrosisChronic Kidney DiseaseOCDPsychosisDrugAlcoholPulmonary HypertensionDeep Vein ThrombosisHeart Disorder None ApplyMetabolic Disorder None ApplyEndocrine Disorder None ApplyRespiratory Disorder None ApplyKidney Disorder None ApplyPsychiatric Illness None ApplyWomens Health None ApplyLiver Disorder None ApplyBrain Disorder None ApplyArthritis None ApplyBlood Disorder None Apply

isApplicablestring

Indicator flag for medical history questions

Allowed values:YesNo

treatmentIndstring

Indicator flag for treatment indicator

Allowed values:YesNoUnknown

recoveredStatusstring

Indicator flag for recovered status

Allowed values:YesNoUnknown

stagestring

Condition Stage

Example:Stage 1

organCancerSpreadIndstring

Indicator flag for organ cancer spread

Allowed values:YesNoUnknown

basalSquamousSkinCancerIndstring

Indicator flag for basal or squamous cell skin cancer

Allowed values:YesNo

resultsKnownIndstring

Indicator flag for test result value

Allowed values:YesNoUnknown

bipolarSuicideIndstring

Indicator flag for bipolar Suicide

Allowed values:YesNo

motorAccidentIndstring

Indicator flag for motar accident

Allowed values:YesNo

resultsReadingstring

Results reading

Example:70

resultsReadingDatestring(date)

Last result reading date

diagnosisDatestring(date)

Treatment Date

systolicBPReadingstring

BP reading upper

Example:140

diastolicBPReadingstring

BP reading lower

Example:70

yearOfFirstSeizurestring

Year of first seizure in case of epilepsy

Example:2001

dateOfLastSeizurestring(date)

Last Seizure date if applicable

numberOfSeizurestring

number of seizure in past year. Maximum value applicable is 10.

Example:6

raLmtdFingToesIndstring

Indicator flag for Rheumatoid arthritis limitation

Allowed values:YesNoUnknown

workSchlHmActRAIndstring

Indicator flag for Rheumatoid arthritis life impact

Allowed values:YesNoUnknown

treatmentDetailarray[object]

Show Child Parameters

substanceUsagearray[object]

Show Child Parameters

Example

treatmentTypestring

Treatment Type

Allowed values:MedicationHospitalizationCPAPSurgeryChemotherapyRadiationOtherTestMedication AddedMedication IncreasedQuit MedicationNone

isApplicablestring

Indicator flag for recovered status

Allowed values:YesNoUnknown

descriptionstring

treatment description

Example:other type of treatment

treatmentCompletionIndstring

Indicator flag for treatment completion

Allowed values:YesNoUnknown

otherTestRecommendIndstring

Indicator flag for other test recommendation

Allowed values:YesNoUnknown

complicationsIndstring

Indicator flag for treatment complication

Allowed values:YesNoUnknown

dateLastSeenstring(date)

Last seen date for treatment observation

medicationstring

treatment description

Example:prescribed pain meds

treatmentStartDatestring(date)

treatmentStartDate in ‘YYYY-MM-DD’ format.

Example

bankruptcyFiledIndstring

Indicator flag for bankruptcy

Allowed values:YesNo

bankruptcyDischargeDatestring(date)

Discharge date of bankruptcy in YYYY-MM-DD format.

privatePilotLast10YrsIndstring

Indicator flag for flying history

Allowed values:YesNoUnknown

privateFlyingDetailsobject

Show Child Parameters

flyExperimentalIndstring

Indicator flag for flying experience

Allowed values:YesNoUnknown

plantoFlyNext2YrsIndstring

Indicator flag for future flying plans

Allowed values:YesNoUnknown

airRacingIndstring

Indicator flag for air racing

Allowed values:YesNoUnknown

diagnosticTestIndstring

Indicator flag for diagnostic tests

Allowed values:YesNoUnknown

skyDiveIndstring

Indicator flag for sky diving

Allowed values:YesNoUnknown

scubaDivingIndstring

Indicator flag for scuba diving

Allowed values:YesNoUnknown

wingSuitSoaringIndstring

Indicator flag

Allowed values:YesNoUnknown

baseJumpSkiingIndstring

Indicator flag for jump skiing

Allowed values:YesNoUnknown

motorCrossIndstring

Indicator flag

Allowed values:YesNoUnknown

hangGlidingIndstring

Indicator flag

Allowed values:YesNoUnknown

noActivityPlannedIndstring

Indicator flag for no activity

Allowed values:YesNoUnknown

motorRacingIndstring

Indicator flag for motor racing

Allowed values:YesNoUnknown

freeDivingAbove50ftIndstring

Indicator flag for diving

Allowed values:YesNoUnknown

climbingIndstring

Indicator flag for climbing

Allowed values:YesNoUnknown

highRiskPlanNext2YrsIndstring

Indicator flag for high risk activity

Allowed values:YesNo

Example

AdditionalInformation

RiskInformation

TreatmentDetail

LifeStyleActivities