Provider Documentation

"Am I a Candidate?" Form Data Transfer

Overview

In an effort to streamline patient qualification and outreach, Spark Biomedical has created a simple, straight-forward process for telehealth provider partners ("Provider" or "Providers") to get access to real-time patient candidate (the "Candidate" or "Candidates") information submitted to our "Am I a Candidate?" form (the "Form").

Requirements

The Form is built using the Jotform platform and their HIPAA compliant account features. Spark has developed a simple, automated process for passing data from Jotform to our provider partners using webhooks. Any partner wishing to receive Candidate information from our form must provide a valid, encrypted (HTTPS) Webhook URL (the "Provider Webhook") for transmission of form data.

Data Flow

Candidates will submit their information via the Form located at SparrowRX.com. Spark Biomedical will disqualify certain submissions based on specific criteria (DOCUMENT THIS?) to prevent unqualified Candidates' information from being delivered to our Providers. Qualifying Candidate data is sent from Jotform (via a webhook) to Spark Biomedical's cloud services and then routed to the appropriate Provider (DOCUMENT THIS?). The raw Jotform webhook data is then passed to your Provider Webhook.

Data Structure and Format

Spark Biomedical's cloud services do not alter the data from Jotform, we simply route it to the appropriate Provider. Jotform webhooks provide form submission data via a form-data body of an HTTP(S) request. The data can be found in the "rawRequest" field of the form. rawRequest data is in JSON format. See the table below for the list of fields and possible values.

Versioning

The structure, format, and delivery of this data is subject to change. We make efforts to not make unnecessary changes to this process, however at times it may be necessary as we work to better onboard, qualify, and serve our users. Changes to this API will be communicated as follows: (DOCUMENT THIS?)

Data Fields & Formats

Field Name
Question / Description
Options
q1_email
String
Required
User's email address
q24_name
Object
Required
User's name
q24_name.first
String
Required
First name
q24_name.last
String
Required
Last name
q2_address
Object
Required
User's street address
q2_address.addr_line1
String
Required
Address line 1
q2_address.addr_line2
String
Address line 2
q2_address.city
String
Required
Address city
q2_address.state
String
Required
Address state
q2_address.postal
String
Required
Address postal code
q22_phone
String
Required
Phone number
Format:
(###) ###-####
q3_reason
String
Required
"What brings you to Spark Biomedical today?"
I'm considering opioid use disorder recovery and am just researching my options.
I'm actively looking for a drug-free opioid withdrawal treatment option.
I am currently in opioid withdrawal.
I'm researching on behalf of another person.
q4_medical_history
Array of Strings
Required
"Do any of the following apply to you?"
I am under 18 years old.
I don’t have a safe current living environment.
I am currently or may be pregnant.
I have a history of seizures.
I currently have an implantable stimulator, such as a spinal cord stimulator, pacemaker, cochlear implant, interstim, etc.
I have had a recent suicide attempt leading to hospitalization.
None of the above
q5_opiods
Array of Strings
Required
"Which opiods are you taking?"
Fentanyl
Methadone
Buprenorphine (Suboxone)
Heroin
Other (Vicodin, Codeine, OxyContin, etc.)
q16_cost_agreement
String
Required
"I understand the Sparrow Ascent is not currently covered by insurance and I am willing to pay the $3,100 cost for this device."
One of:
YES
NO
q15_message_for_provider
Open Text Field
Required
"Is there anything further you'd like your provider to know?"