"laoreet nonummy",
"LastName" => "diam euismod",
"Email" => "sample@gmail.com",
"Phone" => "+1 987 654 321",
"Purpose" => "dolor elit tincidunt. sed laore",
"StrDueDate" => "MM-dd-YYYY",
"StrDOB" => "MM-dd-YYYY",
"Signature" => "jpeg image converted to base64",
"InsuranceNumber" => "INS1234",
"InsuranceCompany" => "nonummy laoreet",
"InsuranceGroup" => "diam laoreet",
"IsBreastPumpNeeded" => true, // or false
"SSNNUmber" => "SSNNumber",
"IsInsuranceRequired" => true, // or false
"Address" => "ipsum lorem aliquam magna. ut lorem mag",
"Address2" => "magna ipsum ipsum dolor. adipiscing elit",
"Apt" => "Apartment tincidunt diam elit amet tincidunt. sed tincid",
"City" => "adipiscing",
"State" => "laoreet amet.",
"Zip" => "elit erat ut",
"DoctorName" => "elit tincidunt diam sit",
"DoctorPhone" => "+1 987 654 321",
"FSA" => "",
"NewsLetter" => true, // or false
);
$ch = curl_init($url);
curl_setopt($ch, CURLOPT_RETURNTRANSFER, true);
curl_setopt($ch, CURLOPT_POSTFIELDS, json_encode($payload));
curl_setopt($ch, CURLOPT_HTTPHEADER, array(
"ClientId: $client_id",
"SecretKey: $secret_key",
"Content-Type: application/json",
));
$response = curl_exec($ch);
if (curl_getinfo($ch, CURLINFO_HTTP_CODE) == 200) {
echo "Request successful!\n";
echo $response;
} else {
echo "Request failed with status code: " . curl_getinfo($ch, CURLINFO_HTTP_CODE) . "\n";
echo $response;
}
curl_close($ch);
?>
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