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- {
- "email": "{{email}}",
- "phone": "{{phone||phone:10}}",
- "firstName": "{{first_name}}",
- "lastName": "{{last_name}}",
- "name": "{{first_name}} {{last_name}}",
- "dateOfBirth": "{{date_of_birth}}",
- "address1": "{{address}}",
- "city": "{{city}}",
- "state": "{{state}}",
- "country": "US",
- "postalCode": "{{zip_code}}",
- "tags": [
- "lead prosper",
- "obamacare",
- "adswapper"
- ],
- "source": "public api",
- "customField": {
- "annual_household_income": "{{annual_household_income}}",
- "social_security_number": "{{ssn}}",
- "gender": "{{gender}}",
- "marital_status": "{{martial_status}}",
- "tobacco_use": "{{tabaco_use}}",
- "household_makeup": "{{household_makeup}}",
- "how_many_tax_dependents_do_you_have": "{{number_of_dependents}}",
- "are_you_selfemployed": "{{is_self_employed}}",
- "employer_name": "{{employer_name}}",
- "employer_address": "{{employer_address}}",
- "employer_phone_number": "{{employer_phone_number}}",
- "i_attest_that_i_qualify_for_one_of_the_following_special_enrollment_periods": "{{Special_enrollment_period_reason}}",
- "has_health_insurance": "{{has_health_insurance}}",
- "spouse_first_name": "{{Spouse_First_Name}}",
- "spouse_last_name": "{{Spouse_Last_Name}}",
- "spouse_date_of_birth": "{{Spouse_Date_of_Birth}}",
- "spouse_social_security_number": "{{Spouse_Social_Security_Number}}",
- "does_spouse_need_health_insurance": "{{Does_Spouse_need_health_insurance}}",
- "is_spouse_selfemployed": "{{Is_Spouse_self-employed}}",
- "spouses_employer_name": "{{spouse_employer_name}}",
- "spouses_employer_address": "{{spouse_employer_address}}",
- "spouse_employer_phone_number": "{{spouse_employer_phone_number}}",
- "spouse_email": "{{Spouse_Email}}",
- "spouse_phone": "{{Spouse_Phone}}",
- "child_1_first_name": "{{Child_1_First_Name}}",
- "child_1_last_name": "{{Child_1_Last_Name}}",
- "child_1_date_of_birth": "{{Child_1_Date_of_Birth}}",
- "child_1_social_security_number": "{{Child_1_Social_Security_Number}}",
- "does_child_1_need_health_insurance": "{{Does_Child_1_need_health_insurance}}",
- "child_2_first_name": "{{Child_2_First_Name}}",
- "child_2_last_name": "{{Child_2_Last_Name}}",
- "child_2_date_of_birth": "{{Child_2_Date_of_Birth}}",
- "child_2_social_security_number": "{{Child_2_Social_Security_Number}}",
- "does_child_2_need_health_insurance": "{{Does_Child_2_need_health_insurance}}",
- "child_3_first_name": "{{Child_3_First_Name}}",
- "child_3_last_name": "{{Child_3_Last_Name}}",
- "child_3_date_of_birth": "{{Child_3_Date_of_Birth}}",
- "child_3_social_security_number": "{{Child_3_Social_Security_Number}}",
- "does_child_3_need_health_insurance": "{{Does_Child_3_need_health_insurance}}",
- "child_4_first_name": "{{Child_4_First_Name}}",
- "child_4_last_name": "{{Child_4_Last_Name}}",
- "child_4_date_of_birth": "{{Child_4_Date_of_Birth}}",
- "child_4_social_security_number": "{{Child_4_Social_Security_Number}}",
- "does_child_4_need_health_insurance": "{{Does_Child_4_need_health_insurance}}",
- "child_5_first_name": "{{Child_5_First_Name}}",
- "child_5_last_name": "{{Child_5_Last_Name}}",
- "child_5_date_of_birth": "{{Child_5_Date_of_Birth}}",
- "child_5_social_security_number": "{{Child_5_Social_Security_Number}}",
- "does_child_5_need_health_insurance": "{{Does_Child_5_need_health_insurance}}",
- "multiline_field_for_the_rest_of_the_childrens_names_dobs_ssns_etc": "{{Rest_of_Children}}",
- "signature": "{{Signature}}",
- "agent_of_record_confirmation": "{{Agent_of_record_confirmation}}",
- "limited_power_of_attorney": "{{Limited_power_of_attorney}}",
- "agree_to_be_enrolled": "{{Agree_to_enroll}}",
- "right_to_cancel": "{{Right_to_cancel}}",
- "permission_to_access_hc_gov_account": "{{Permission_for_healthcare_account}}",
- "confirm_that_plan_options_vary": "{{Confirm_plan_options_vary}}",
- "date": "{{lp_date||date:Y-m-d}}T{{lp_date||date:H:i:s}}",
- "ip_address": "{{ip_address}}",
- "user_agent": "{{user_agent}}",
- "landing_page_url": "{{landing_page_url}}",
- "jornaya_lead_id": "{{jornaya_leadid}}",
- "trusted_form_cert_url": "{{trustedform_cert_url}}",
- "click_id": "{{clickid}}",
- "lead_Source": "source"
- }
- }
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