sample.js

export default {
  billing: {
    claimsSubmissionAddress:
      'Second Floor, Bajaj Insurance, Hi Tech city, Hyderabad',
    groupNumber: '12345',
    isESInsurance: false,
    plan: 'platinum',
    policyHolder: {
      dob: '05/19/1999',
      name: 'Ashfaq',
      relationship: 'self'
    },
    policyNumber: '12345',
    primaryInsurance: 'Bajaj',
    primaryInsuranceType: 'Private',
    priorAuthorizationCode: ''
  },
  order: {
    dateOfOrder: '05/19/1999',
    icdCode: 'z12'
  },
  patient: {
    billingAddress: {
      city: 'Hyderabad',
      line1: 'Flat No 402, Gachibowli',
      line2: 'Hyderabad, Telangana',
      state: 'Telangana',
      zip: '500006'
    },
    dob: '05/19/1999',
    firstName: 'Ashfaq',
    id: '12345',
    isHispanicLatinoOrigin: false,
    languagePreference: 'English',
    lastName: 'Nisar',
    number: '8328277518',
    race: 'Asian',
    sex: 'Male',
    shippingAddress: {
      city: 'Hyderabad',
      line1: 'Flat No 402, Gachibowli',
      line2: 'Hyderabad',
      state: 'Telangana',
      zip: '500006'
    }
  },
  provider: {
    NPI: 1479560428,
    address: 'Flat No 402, Gachibowli',
    city: 'Bancroft',
    faxNumber: '1234567890',
    healthCare: 'Treejoy HealthCare',
    name: 'Vamshi',
    number: '8328277518',
    state: ' Alaska',
    zip: ' 870039 '
  }
};