{"id":546,"date":"2020-03-13T09:44:04","date_gmt":"2020-03-13T09:44:04","guid":{"rendered":"https:\/\/salute.vamtam.com\/?page_id=546"},"modified":"2023-03-22T06:59:28","modified_gmt":"2023-03-22T06:59:28","slug":"intake-form-new-patient","status":"publish","type":"page","link":"https:\/\/mymentalhealthtms.com\/index.php\/intake-form-new-patient\/","title":{"rendered":"Intake Form &#038; New Patient Paperwork"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"546\" class=\"elementor elementor-546\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-476119cb elementor-section-height-min-height elementor-section-items-stretch elementor-section-boxed elementor-section-height-default\" data-id=\"476119cb\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-450aa483\" data-id=\"450aa483\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-324556e0 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"324556e0\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-1f6d39a0\" data-id=\"1f6d39a0\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2ae3b0e0 elementor-widget elementor-widget-heading\" data-id=\"2ae3b0e0\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.17.0 - 08-11-2023 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h1 class=\"elementor-heading-title elementor-size-default\">New Patients<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-50bb9989 elementor-section-height-min-height elementor-section-items-stretch elementor-section-boxed elementor-section-height-default\" data-id=\"50bb9989\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-2e69d87b\" data-id=\"2e69d87b\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-282a5168 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"282a5168\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-328bbb9\" data-id=\"328bbb9\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-9ba99fb elementor-align-left elementor-mobile-align-left elementor-widget-mobile__width-auto elementor-widget elementor-widget-button\" data-id=\"9ba99fb\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/mymentalhealthtms.com\/index.php\/request-an-appointment\/\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-text\">Request Appointment ><\/span>\n\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-2f5b3eb6 elementor-hidden-phone\" data-id=\"2f5b3eb6\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-785a8f05 elementor-widget__width-auto elementor-view-default elementor-widget elementor-widget-icon\" data-id=\"785a8f05\" data-element_type=\"widget\" data-widget_type=\"icon.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<div class=\"elementor-icon\">\n\t\t\t<i aria-hidden=\"true\" class=\"vamtamtheme- vamtam-theme-emergency-phone\"><\/i>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-44af653d elementor-widget__width-auto elementor-widget elementor-widget-heading\" data-id=\"44af653d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h5 class=\"elementor-heading-title elementor-size-default\"><a href=\"tel:+1%20443-354-1200\">+1 443-354-1200<\/a><\/h5>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-53ed28a elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"53ed28a\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-15433ab\" data-id=\"15433ab\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-9857214 elementor-widget elementor-widget-template\" data-id=\"9857214\" data-element_type=\"widget\" data-widget_type=\"template.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-template\">\n\t\t\t\t\t<div data-elementor-type=\"section\" data-elementor-id=\"989258\" class=\"elementor elementor-989258\" data-elementor-post-type=\"elementor_library\">\n\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7a28ac19 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7a28ac19\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-79f2e67a\" data-id=\"79f2e67a\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3ec94a8a elementor-widget__width-auto elementor-widget elementor-widget-text-editor\" data-id=\"3ec94a8a\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.17.0 - 08-11-2023 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<h6>ACCEPTED<br>INSURANCE:<\/h6>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-76063e77\" data-id=\"76063e77\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-14a029b7 elementor-widget elementor-widget-image-carousel\" data-id=\"14a029b7\" data-element_type=\"widget\" data-settings=\"{&quot;slides_to_show&quot;:&quot;4&quot;,&quot;navigation&quot;:&quot;none&quot;,&quot;slides_to_show_mobile&quot;:&quot;2&quot;,&quot;slides_to_scroll_mobile&quot;:&quot;1&quot;,&quot;slides_to_show_tablet&quot;:&quot;4&quot;,&quot;slides_to_scroll_tablet&quot;:&quot;3&quot;,&quot;pause_on_hover&quot;:&quot;no&quot;,&quot;autoplay_speed&quot;:1500,&quot;speed&quot;:600,&quot;autoplay&quot;:&quot;yes&quot;,&quot;pause_on_interaction&quot;:&quot;yes&quot;,&quot;infinite&quot;:&quot;yes&quot;}\" data-widget_type=\"image-carousel.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.17.0 - 08-11-2023 *\/\n.elementor-widget-image-carousel .swiper,.elementor-widget-image-carousel .swiper-container{position:static}.elementor-widget-image-carousel .swiper-container .swiper-slide figure,.elementor-widget-image-carousel .swiper .swiper-slide figure{line-height:inherit}.elementor-widget-image-carousel .swiper-slide{text-align:center}.elementor-image-carousel-wrapper:not(.swiper-container-initialized):not(.swiper-initialized) .swiper-slide{max-width:calc(100% \/ var(--e-image-carousel-slides-to-show, 3))}<\/style>\t\t<div class=\"elementor-image-carousel-wrapper swiper-container\" dir=\"ltr\">\n\t\t\t<div class=\"elementor-image-carousel swiper-wrapper\" aria-live=\"off\">\n\t\t\t\t\t\t\t\t<div class=\"swiper-slide\" role=\"group\" aria-roledescription=\"slide\" aria-label=\"1 of 4\"><figure class=\"swiper-slide-inner\"><img decoding=\"async\" class=\"swiper-slide-image\" src=\"https:\/\/mymentalhealthtms.com\/wp-content\/uploads\/2021\/09\/logos-6.webp\" alt=\"logos-6\" \/><\/figure><\/div><div class=\"swiper-slide\" role=\"group\" aria-roledescription=\"slide\" aria-label=\"2 of 4\"><figure class=\"swiper-slide-inner\"><img decoding=\"async\" class=\"swiper-slide-image\" src=\"https:\/\/mymentalhealthtms.com\/wp-content\/uploads\/2021\/10\/logo-medicare.png\" alt=\"logo-medicare\" \/><\/figure><\/div><div class=\"swiper-slide\" role=\"group\" aria-roledescription=\"slide\" aria-label=\"3 of 4\"><figure class=\"swiper-slide-inner\"><img decoding=\"async\" class=\"swiper-slide-image\" src=\"https:\/\/mymentalhealthtms.com\/wp-content\/uploads\/2021\/10\/logo-carefirst-1.png\" alt=\"logo-carefirst\" \/><\/figure><\/div><div class=\"swiper-slide\" role=\"group\" aria-roledescription=\"slide\" aria-label=\"4 of 4\"><figure class=\"swiper-slide-inner\"><img decoding=\"async\" class=\"swiper-slide-image\" src=\"https:\/\/mymentalhealthtms.com\/wp-content\/uploads\/2021\/10\/logo-tricare-1.png\" alt=\"logo-tricare\" \/><\/figure><\/div>\t\t\t<\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5487782 elementor-section-height-min-height elementor-section-items-stretch elementor-section-boxed elementor-section-height-default\" data-id=\"5487782\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-e963990\" data-id=\"e963990\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-51416d0 elementor-widget elementor-widget-wp-widget-ninja_forms_widget\" data-id=\"51416d0\" data-element_type=\"widget\" data-widget_type=\"wp-widget-ninja_forms_widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<noscript class=\"ninja-forms-noscript-message\">\n\tNotice: JavaScript is required for this content.<\/noscript>\n<div id=\"nf-form-2-cont\" class=\"nf-form-cont contact-form\" aria-live=\"polite\" aria-labelledby=\"nf-form-title-2\" aria-describedby=\"nf-form-errors-2\" role=\"form\">\n\n    <div class=\"nf-loading-spinner\"><\/div>\n\n<\/div>\n        <!-- That data is being printed as a workaround to page builders reordering the order of the scripts loaded-->\n        <script>var formDisplay=1;var nfForms=nfForms||[];var form=[];form.id='2';form.settings={\"objectType\":\"Form Setting\",\"editActive\":true,\"title\":\"MY Mental Health LLC, Intake Form\",\"created_at\":\"2021-10-15 23:49:33\",\"form_title\":\"MY Mental Health LLC, Intake Form\",\"default_label_pos\":\"above\",\"show_title\":\"1\",\"clear_complete\":\"1\",\"hide_complete\":\"1\",\"logged_in\":\"0\",\"wrapper_class\":\"contact-form\",\"element_class\":\"\",\"key\":\"\",\"add_submit\":\"1\",\"currency\":\"\",\"unique_field_error\":\"A form with this value has already been submitted.\",\"not_logged_in_msg\":\"\",\"sub_limit_msg\":\"The form has reached its submission limit.\",\"calculations\":[],\"formContentData\":[\"legal_first_and_last_name_1683091783365\",\"preferred_name_1683091791085\",\"gender_1683091811409\",\"preferred_pronouns_1683092083482\",\"d_o_b_1504525249967\",\"address_1504524507300\",\"apt_1504525286657\",\"city_1504524535390\",\"zip_1504524544482\",\"phone_1504524564888\",\"email_you_will_be_contacted_by_email_for_scheduling_1603394307682\",\"primary_physician_1504525329848\",\"did_they_refer_you_to_mmh_1504588819185\",\"if_not_how_did_they_hear_about_mmh_1590678505730\",\"other_1504589203482\",\"insurance_provider_1504589527323\",\"other_1504589606228\",\"primary_reason_for_visit_1504589718813\",\"please_provide_details_related_to_conditions_listed_1678349115173\",\"ptsd_specifics_1504525631704\",\"other_1504525694591\",\"are_you_looking_for_please_select_all_that_apply_1613419754520\",\"which_location_do_you_prefer_1604584274606\",\"if_you_have_a_therapist_name_1603902903262\",\"phone_number_1504526196845\",\"if_you_have_a_med_provider_name_1603902923721\",\"phone_number_1504526407997\",\"have_you_had_any_previous_treatment_for_the_above_1504590163000\",\"who_1504526513394\",\"when_1590678268855\",\"how_long_did_you_see_them_1504526782043\",\"are_you_currently_on_any_medication_1504590284139\",\"table_1504526919276\",\"current_medications_and_dosages_1611088632276\",\"do_you_see_a_pain_management_doctor_or_taking_any_pain_medication_1504590370176\",\"who_1504590439814\",\"what_pain_medication_are_you_on_1504590808449\",\"in_the_past_have_you_used_illegal_drugs_or_prescription_medications_for_nonmedical_reasons_one_or_more_times_in_the_past_1504590881353\",\"what_1504527233294\",\"last_used_1504527253968\",\"have_you_ever_been_treated_for_substance_abuse_1504590956958\",\"what_substance_1504527350113\",\"where_did_you_receive_treatment_1504527370648\",\"how_long_ago_did_you_last_use_1504527393541\",\"have_you_thought_about_or_attempted_suicide_in_the_last_year_1504591008459\",\"how_long_ago_1504527485264\",\"what_was_the_outcome_1504527498499\",\"were_you_sent_to_the_hospital_1603902974632\",\"have_you_ever_attempted_or_harmed_others_1504591117928\",\"how_did_you_harm_them_1504527641740\",\"do_you_have_pending_charges_1504591161463\",\"were_you_arrested_1603903028195\",\"have_you_ever_been_admitted_to_a_hospital_outpatient_or_an_inpatient_treatment_center_1504591201312\",\"when_1504527781682\",\"where_1504527799799\",\"how_long_1504527819582\",\"insurance_provider_1590678213166\",\"primary_insurance_1603903045326\",\"member_id_1504527955374\",\"group_number_1504527978834\",\"subscriber_1504527990235\",\"subscriber_d_o_b_1504528037333\",\"address_1504528047594\",\"phone_1504528055935\",\"relation_1504528122707\",\"insurance_benefits_number_on_back_of_card_1602605363500\",\"secondary_insurance_1504591395368\",\"member_id_1504528357332\",\"group_number_1504528345888\",\"subscriber_1504528351913\",\"subscriber_d_o_b_1504528341915\",\"address_1504528336888\",\"phone_1504528333103\",\"relation_1504528327965\",\"insurance_benefits_number_1504528322278\",\"submit_1504526045020\"],\"changeEmailErrorMsg\":\"Please enter a valid email address!\",\"confirmFieldErrorMsg\":\"These fields must match!\",\"fieldNumberNumMinError\":\"Number Min Error\",\"fieldNumberNumMaxError\":\"Number Max Error\",\"fieldNumberIncrementBy\":\"Please increment by \",\"formErrorsCorrectErrors\":\"Please correct errors before submitting this form.\",\"validateRequiredField\":\"This is a required field.\",\"honeypotHoneypotError\":\"Honeypot Error\",\"fieldsMarkedRequired\":\"Fields marked with an <span class=\\\"ninja-forms-req-symbol\\\">*<\\\/span> are required\",\"drawerDisabled\":false,\"repeatable_fieldsets\":\"\",\"allow_public_link\":0,\"embed_form\":\"\",\"form_title_heading_level\":\"3\",\"changeDateErrorMsg\":\"Please enter a valid date!\",\"ninjaForms\":\"Ninja Forms\",\"fieldTextareaRTEInsertLink\":\"Insert Link\",\"fieldTextareaRTEInsertMedia\":\"Insert Media\",\"fieldTextareaRTESelectAFile\":\"Select a file\",\"formHoneypot\":\"If you are a human seeing this field, please leave it empty.\",\"fileUploadOldCodeFileUploadInProgress\":\"File Upload in Progress.\",\"fileUploadOldCodeFileUpload\":\"FILE UPLOAD\",\"currencySymbol\":\"&#36;\",\"thousands_sep\":\",\",\"decimal_point\":\".\",\"siteLocale\":\"en_US\",\"dateFormat\":\"m\\\/d\\\/Y\",\"startOfWeek\":\"1\",\"of\":\"of\",\"previousMonth\":\"Previous Month\",\"nextMonth\":\"Next Month\",\"months\":[\"January\",\"February\",\"March\",\"April\",\"May\",\"June\",\"July\",\"August\",\"September\",\"October\",\"November\",\"December\"],\"monthsShort\":[\"Jan\",\"Feb\",\"Mar\",\"Apr\",\"May\",\"Jun\",\"Jul\",\"Aug\",\"Sep\",\"Oct\",\"Nov\",\"Dec\"],\"weekdays\":[\"Sunday\",\"Monday\",\"Tuesday\",\"Wednesday\",\"Thursday\",\"Friday\",\"Saturday\"],\"weekdaysShort\":[\"Sun\",\"Mon\",\"Tue\",\"Wed\",\"Thu\",\"Fri\",\"Sat\"],\"weekdaysMin\":[\"Su\",\"Mo\",\"Tu\",\"We\",\"Th\",\"Fr\",\"Sa\"],\"recaptchaConsentMissing\":\"reCaptcha validation couldn&#039;t load.\",\"recaptchaMissingCookie\":\"reCaptcha v3 validation couldn&#039;t load the cookie needed to submit the form.\",\"recaptchaConsentEvent\":\"Accept reCaptcha cookies before sending the form.\",\"currency_symbol\":\"\",\"beforeForm\":\"\",\"beforeFields\":\"\",\"afterFields\":\"\",\"afterForm\":\"\"};form.fields=[{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":1,\"idAttribute\":\"id\",\"type\":\"firstname\",\"label\":\"Legal First and Last Name\",\"key\":\"legal_first_and_last_name_1683091783365\",\"label_pos\":\"above\",\"required\":1,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"fname\",\"personally_identifiable\":1,\"value\":\"\",\"field_label\":\"Name\",\"field_key\":\"name_1504525213621\",\"id\":78,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"firstname\",\"element_templates\":[\"firstname\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":2,\"idAttribute\":\"id\",\"type\":\"firstname\",\"label\":\"Preferred Name\",\"key\":\"preferred_name_1683091791085\",\"label_pos\":\"above\",\"required\":1,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"drawerDisabled\":false,\"custom_name_attribute\":\"fname\",\"personally_identifiable\":1,\"value\":\"\",\"field_label\":\"Name\",\"field_key\":\"name_1504525213621\",\"id\":5,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"firstname\",\"element_templates\":[\"firstname\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":3,\"idAttribute\":\"id\",\"label\":\"Gender\",\"type\":\"listselect\",\"key\":\"gender_1683091811409\",\"label_pos\":\"above\",\"required\":1,\"options\":[{\"errors\":[],\"max_options\":0,\"label\":\"Woman\",\"value\":\"woman\",\"calc\":\"\",\"selected\":0,\"order\":1,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":true},{\"errors\":[],\"max_options\":0,\"label\":\"Man\",\"value\":\"man\",\"calc\":\"\",\"selected\":0,\"order\":2,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":true},{\"errors\":[],\"max_options\":0,\"label\":\"Transgender\",\"value\":\"transgender\",\"calc\":\"\",\"selected\":0,\"order\":3,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":true},{\"errors\":[],\"max_options\":0,\"order\":4,\"new\":false,\"options\":[],\"label\":\"Non-binary\\\/non-conforming\",\"value\":\"non-binary-non-conforming\",\"calc\":\"\",\"selected\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":true},{\"errors\":[],\"max_options\":0,\"order\":5,\"new\":false,\"options\":[],\"label\":\"Prefer not to respond\",\"value\":\"prefer-not-to-respond\",\"calc\":\"\",\"selected\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":true}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"Gender\",\"help_text\":\"<p><span style=\\\"caret-color: rgb(34, 34, 34); color: rgb(34, 34, 34); font-family: Arial, Helvetica, sans-serif; font-size: small;\\\">Please select one of the following<\\\/span><br><\\\/p>\",\"desc_text\":\"<p><span style=\\\"caret-color: rgb(34, 34, 34); color: rgb(34, 34, 34); font-family: Arial, Helvetica, sans-serif; font-size: small;\\\">Please select one of the following<\\\/span><br><\\\/p>\",\"drawerDisabled\":false,\"id\":79,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"list\",\"element_templates\":[\"listselect\",\"input\"],\"old_classname\":\"list-select\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":4,\"idAttribute\":\"id\",\"label\":\"Preferred Pronouns\",\"type\":\"textbox\",\"key\":\"preferred_pronouns_1683092083482\",\"label_pos\":\"above\",\"required\":false,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"admin_label\":\"Preferred Pronouns\",\"help_text\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"drawerDisabled\":false,\"id\":80,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":5,\"idAttribute\":\"id\",\"type\":\"date\",\"label\":\"D.O.B\",\"key\":\"d_o_b_1504525249967\",\"label_pos\":\"above\",\"required\":1,\"container_class\":\"\",\"element_class\":\"\",\"manual_key\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"date_default\":\"\",\"date_format\":\"dddd, MMMM D YYYY\",\"year_range_start\":1930,\"year_range_end\":2016,\"drawerDisabled\":\"\",\"placeholder\":\"\",\"date_mode\":\"date_only\",\"hours_24\":0,\"minute_increment\":5,\"field_label\":\"D.O.B\",\"field_key\":\"d_o_b_1504525249967\",\"id\":6,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"date\",\"element_templates\":[\"date\",\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":6,\"idAttribute\":\"id\",\"type\":\"address\",\"label\":\"Address\",\"key\":\"address_1504524507300\",\"label_pos\":\"above\",\"required\":1,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"custom_name_attribute\":\"address\",\"personally_identifiable\":1,\"value\":\"\",\"field_label\":\"Address\",\"field_key\":\"address_1504524507300\",\"id\":7,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"address\",\"element_templates\":[\"address\",\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":7,\"idAttribute\":\"id\",\"type\":\"textbox\",\"label\":\"Apt\",\"key\":\"apt_1504525286657\",\"label_pos\":\"above\",\"required\":0,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"Apt\",\"field_key\":\"apt_1504525286657\",\"id\":8,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":8,\"idAttribute\":\"id\",\"type\":\"city\",\"label\":\"City\",\"key\":\"city_1504524535390\",\"label_pos\":\"above\",\"required\":1,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"custom_name_attribute\":\"city\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"City\",\"field_key\":\"city_1504524535390\",\"id\":9,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"city\",\"element_templates\":[\"city\",\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":9,\"idAttribute\":\"id\",\"type\":\"zip\",\"label\":\"Zip\",\"key\":\"zip_1504524544482\",\"label_pos\":\"above\",\"required\":1,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"custom_name_attribute\":\"zip\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"Zip\",\"field_key\":\"zip_1504524544482\",\"id\":10,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"zip\",\"element_templates\":[\"zip\",\"textbox\",\"input\",\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":10,\"idAttribute\":\"id\",\"type\":\"phone\",\"label\":\"Phone\",\"key\":\"phone_1504524564888\",\"label_pos\":\"above\",\"required\":1,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"custom_name_attribute\":\"phone\",\"personally_identifiable\":1,\"value\":\"\",\"field_label\":\"Phone\",\"field_key\":\"phone_1504524564888\",\"id\":11,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"tel\",\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":11,\"idAttribute\":\"id\",\"type\":\"email\",\"label\":\"Email (You will be contacted by email for scheduling)\",\"key\":\"email_you_will_be_contacted_by_email_for_scheduling_1603394307682\",\"label_pos\":\"above\",\"required\":1,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"custom_name_attribute\":\"email\",\"personally_identifiable\":1,\"value\":\"\",\"drawerDisabled\":\"\",\"field_label\":\"Email (You will be contacted by email for scheduling)\",\"field_key\":\"email_you_will_be_contacted_by_email_for_scheduling_1603394307682\",\"id\":12,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"email\",\"element_templates\":[\"email\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":12,\"idAttribute\":\"id\",\"type\":\"textbox\",\"label\":\"Primary Physician \",\"key\":\"primary_physician_1504525329848\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"Primary Physician \",\"field_key\":\"primary_physician_1504525329848\",\"id\":13,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":13,\"idAttribute\":\"id\",\"label\":\"Did they refer you to MMH?\",\"type\":\"listradio\",\"key\":\"did_they_refer_you_to_mmh_1504588819185\",\"label_pos\":\"above\",\"required\":\"\",\"options\":[{\"errors\":[],\"max_options\":\"0\",\"label\":\"Yes \",\"value\":\"yes\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"No\",\"value\":\"no\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"1\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"drawerDisabled\":\"\",\"field_label\":\"Did they refer you to MMH?\",\"field_key\":\"did_they_refer_you_to_mmh_1504588819185\",\"id\":14,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"list\",\"element_templates\":[\"listradio\",\"input\"],\"old_classname\":\"list-radio\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":14,\"idAttribute\":\"id\",\"label\":\"If not, how did they hear about MMH \",\"type\":\"listcheckbox\",\"key\":\"if_not_how_did_they_hear_about_mmh_1590678505730\",\"label_pos\":\"above\",\"required\":\"\",\"options\":[{\"errors\":[],\"max_options\":\"0\",\"label\":\"Friend\",\"value\":\"friend\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"Website\",\"value\":\"website\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"1\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"Insurance\",\"value\":\"insurance\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"2\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"order\":\"3\",\"new\":\"\",\"options\":[],\"label\":\"Radio\",\"value\":\"radio\",\"calc\":\"\",\"selected\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":\"1\"}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"drawerDisabled\":\"\",\"field_label\":\"If not, how did they hear about MMH \",\"field_key\":\"if_not_how_did_they_hear_about_mmh_1590678505730\",\"id\":15,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"list\",\"element_templates\":[\"listcheckbox\",\"input\"],\"old_classname\":\"list-checkbox\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":15,\"idAttribute\":\"id\",\"label\":\"Other\",\"type\":\"textbox\",\"key\":\"other_1504589203482\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"Other\",\"field_key\":\"other_1504589203482\",\"id\":16,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":16,\"idAttribute\":\"id\",\"label\":\"Insurance Provider\",\"type\":\"listcheckbox\",\"key\":\"insurance_provider_1504589527323\",\"label_pos\":\"above\",\"required\":\"\",\"options\":[{\"errors\":[],\"max_options\":\"0\",\"label\":\"BCBS\",\"value\":\"bcbs\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"order\":\"1\",\"new\":\"\",\"options\":[],\"label\":\"BlueChoice \",\"value\":\"bluechoice \",\"calc\":\"\",\"selected\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":\"1\"},{\"errors\":[],\"max_options\":\"0\",\"label\":\"Cigna\",\"value\":\"cigna\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"2\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"order\":\"4\",\"new\":\"\",\"options\":[],\"label\":\" Medicare\",\"value\":\"medicare\",\"calc\":\"\",\"selected\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"order\":\"5\",\"new\":\"\",\"options\":[],\"label\":\"Tricare \",\"value\":\"tricare\",\"calc\":\"\",\"selected\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"order\":\"6\",\"new\":\"\",\"options\":[],\"label\":\"Other \",\"value\":\"other \",\"calc\":\"\",\"selected\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":\"1\"}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"drawerDisabled\":\"\",\"field_label\":\"Insurance Provider\",\"field_key\":\"insurance_provider_1504589527323\",\"id\":17,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"list\",\"element_templates\":[\"listcheckbox\",\"input\"],\"old_classname\":\"list-checkbox\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":17,\"idAttribute\":\"id\",\"label\":\"Other\",\"type\":\"textbox\",\"key\":\"other_1504589606228\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"Other\",\"field_key\":\"other_1504589606228\",\"id\":18,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":18,\"idAttribute\":\"id\",\"label\":\"Primary Reason for Visit\",\"type\":\"listcheckbox\",\"key\":\"primary_reason_for_visit_1504589718813\",\"label_pos\":\"above\",\"required\":1,\"options\":[{\"errors\":[],\"max_options\":\"0\",\"order\":0,\"new\":\"\",\"options\":[],\"label\":\"ADD\\\/ADHD\",\"value\":\"add-adhd\",\"calc\":\"\",\"selected\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":0,\"order\":1,\"new\":false,\"options\":[],\"label\":\"Anger Management\",\"value\":\"anger-management\",\"calc\":\"\",\"selected\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":true},{\"errors\":[],\"max_options\":\"0\",\"label\":\"Anxiety\",\"value\":\"anxiety\",\"calc\":\"\",\"selected\":\"0\",\"order\":2,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"Bipolar Disorder\",\"value\":\"bipolar-disorder\",\"calc\":\"\",\"selected\":\"0\",\"order\":3,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"Depression\",\"value\":\"depression\",\"calc\":\"\",\"selected\":\"0\",\"order\":4,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":0,\"order\":5,\"new\":false,\"options\":[],\"label\":\"Eating Disorder\",\"value\":\"eating-disorder\",\"calc\":\"\",\"selected\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":true},{\"errors\":[],\"max_options\":0,\"order\":6,\"new\":false,\"options\":[],\"label\":\"Family\\\/Relationship Stress\",\"value\":\"family-relationship-stress\",\"calc\":\"\",\"selected\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":true},{\"errors\":[],\"max_options\":0,\"order\":7,\"new\":false,\"options\":[],\"label\":\"Hallucinations (Auditory and\\\/or Visual)\",\"value\":\"hallucinations\",\"calc\":\"\",\"selected\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":true},{\"errors\":[],\"max_options\":0,\"order\":8,\"new\":false,\"options\":[],\"label\":\"Life Stressors\",\"value\":\"life-stressors\",\"calc\":\"\",\"selected\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":true},{\"errors\":[],\"max_options\":0,\"order\":9,\"new\":false,\"options\":[],\"label\":\"Manic Symptoms\",\"value\":\"manic-symptoms\",\"calc\":\"\",\"selected\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":true},{\"errors\":[],\"max_options\":0,\"order\":10,\"new\":false,\"options\":[],\"label\":\"OCD\",\"value\":\"ocd\",\"calc\":\"\",\"selected\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":true},{\"errors\":[],\"max_options\":\"0\",\"order\":11,\"new\":\"\",\"options\":[],\"label\":\"Panic Disorder\",\"value\":\"panic-disorder\",\"calc\":\"\",\"selected\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":0,\"order\":12,\"new\":false,\"options\":[],\"label\":\"Paranoia\",\"value\":\"paranoia\",\"calc\":\"\",\"selected\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":true},{\"errors\":[],\"max_options\":0,\"order\":13,\"new\":false,\"options\":[],\"label\":\"Post Traumatic Stress Disorder\",\"value\":\"post-traumatic-stress-disorder\",\"calc\":\"\",\"selected\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":true},{\"errors\":[],\"max_options\":0,\"order\":14,\"new\":false,\"options\":[],\"label\":\"Personality Disorder\",\"value\":\"personality-disorder\",\"calc\":\"\",\"selected\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":true},{\"errors\":[],\"max_options\":0,\"order\":15,\"new\":false,\"options\":[],\"label\":\"Schizoaffective Disorder\",\"value\":\"schizoaffective-disorder\",\"calc\":\"\",\"selected\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":true},{\"errors\":[],\"max_options\":0,\"order\":16,\"new\":false,\"options\":[],\"label\":\"Schizophrenia\",\"value\":\"schizophrenia\",\"calc\":\"\",\"selected\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":true},{\"errors\":[],\"max_options\":0,\"order\":17,\"new\":false,\"options\":[],\"label\":\"Substance Abuse (Current or Past)\",\"value\":\"substance-abuse\",\"calc\":\"\",\"selected\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":true}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"<p><span style=\\\"caret-color: rgb(34, 34, 34); color: rgb(34, 34, 34); font-family: Arial, Helvetica, sans-serif; font-size: small; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: auto; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); text-decoration: none; display: inline !important; float: none;\\\">Check all that Apply<\\\/span><span style=\\\"caret-color: rgb(34, 34, 34); color: rgb(34, 34, 34); font-family: Arial, Helvetica, sans-serif; font-size: small; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: auto; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); text-decoration: none; display: inline !important; float: none;\\\"><\\\/span><\\\/p>\",\"desc_text\":\"<p><span style=\\\"caret-color: rgb(34, 34, 34); color: rgb(34, 34, 34); font-family: Arial, Helvetica, sans-serif; font-size: small; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: auto; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: auto; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); text-decoration: none; display: inline !important; float: none;\\\">Check all that Apply<\\\/span><br><\\\/p>\",\"drawerDisabled\":false,\"field_label\":\"Primary Reason for Visit\",\"field_key\":\"primary_reason_for_visit_1504589718813\",\"id\":19,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"list\",\"element_templates\":[\"listcheckbox\",\"input\"],\"old_classname\":\"list-checkbox\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":19,\"idAttribute\":\"id\",\"label\":\"Please provide details related to conditions listed\",\"type\":\"textarea\",\"key\":\"please_provide_details_related_to_conditions_listed_1678349115173\",\"label_pos\":\"above\",\"required\":1,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"disable_input\":0,\"admin_label\":\"\",\"help_text\":\"\",\"disable_browser_autocomplete\":0,\"textarea_rte\":1,\"disable_rte_mobile\":\"\",\"textarea_media\":\"\",\"value\":\"\",\"drawerDisabled\":false,\"id\":77,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textarea\",\"element_templates\":[\"textarea\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":20,\"idAttribute\":\"id\",\"label\":\"PTSD: Specifics\",\"type\":\"textbox\",\"key\":\"ptsd_specifics_1504525631704\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"PTSD: Specifics\",\"field_key\":\"ptsd_specifics_1504525631704\",\"id\":20,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":21,\"idAttribute\":\"id\",\"label\":\"Other\",\"type\":\"textbox\",\"key\":\"other_1504525694591\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"Other\",\"field_key\":\"other_1504525694591\",\"id\":21,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":22,\"idAttribute\":\"id\",\"type\":\"listcheckbox\",\"label\":\"Are you looking for? Please select all that apply \",\"key\":\"are_you_looking_for_please_select_all_that_apply_1613419754520\",\"label_pos\":\"above\",\"required\":0,\"options\":[{\"errors\":[],\"max_options\":\"0\",\"label\":\"Talk  Therapy\",\"value\":\"Talk Therapy \",\"calc\":\"\",\"selected\":\"0\",\"order\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":\"1\"},{\"errors\":[],\"max_options\":\"0\",\"label\":\"Medication Management \",\"value\":\"Medication Management\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"1\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":\"1\"},{\"errors\":[],\"max_options\":\"0\",\"order\":\"2\",\"new\":\"\",\"options\":[],\"label\":\"Spravato\",\"value\":\"Spravato\",\"calc\":\"\",\"selected\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":\"1\"}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"drawerDisabled\":\"\",\"field_label\":\"Are you looking for? Please select all that apply \",\"field_key\":\"are_you_looking_for_please_select_all_that_apply_1613419754520\",\"id\":22,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"list\",\"element_templates\":[\"listcheckbox\",\"input\"],\"old_classname\":\"list-checkbox\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":23,\"idAttribute\":\"id\",\"label\":\"Which location do you prefer? \",\"type\":\"listcheckbox\",\"key\":\"which_location_do_you_prefer_1604584274606\",\"label_pos\":\"above\",\"required\":\"\",\"options\":[{\"errors\":[],\"max_options\":\"0\",\"label\":\"Glen Burnie\",\"value\":\"Glen Burnie\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":\"1\"},{\"errors\":[],\"max_options\":\"0\",\"label\":\"Pikesville \",\"value\":\"Pikesville \",\"calc\":\"\",\"selected\":\"0\",\"order\":\"2\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":\"1\"}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"drawerDisabled\":false,\"field_label\":\"Which location do you prefer? \",\"field_key\":\"which_location_do_you_prefer_1604584274606\",\"id\":23,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"list\",\"element_templates\":[\"listcheckbox\",\"input\"],\"old_classname\":\"list-checkbox\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":24,\"idAttribute\":\"id\",\"label\":\"\\u2981\\tIf you have a Therapist Name\",\"type\":\"textbox\",\"key\":\"if_you_have_a_therapist_name_1603902903262\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"\\u2981\\tIf you have a Therapist Name\",\"field_key\":\"if_you_have_a_therapist_name_1603902903262\",\"id\":24,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":25,\"idAttribute\":\"id\",\"type\":\"phone\",\"label\":\"Phone Number\",\"key\":\"phone_number_1504526196845\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"phone\",\"personally_identifiable\":1,\"value\":\"\",\"field_label\":\"Phone Number\",\"field_key\":\"phone_number_1504526196845\",\"id\":25,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"tel\",\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":26,\"idAttribute\":\"id\",\"label\":\"\\u2981\\tIf you have a Med Provider Name\\t\",\"type\":\"textbox\",\"key\":\"if_you_have_a_med_provider_name_1603902923721\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"\\u2981\\tIf you have a Med Provider Name\\t\",\"field_key\":\"if_you_have_a_med_provider_name_1603902923721\",\"id\":26,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":27,\"idAttribute\":\"id\",\"label\":\"Phone Number\",\"type\":\"phone\",\"key\":\"phone_number_1504526407997\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"phone\",\"personally_identifiable\":1,\"value\":\"\",\"field_label\":\"Phone Number\",\"field_key\":\"phone_number_1504526407997\",\"id\":27,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"tel\",\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":28,\"idAttribute\":\"id\",\"label\":\"Have you had any previous treatment for the above?\",\"type\":\"listradio\",\"key\":\"have_you_had_any_previous_treatment_for_the_above_1504590163000\",\"label_pos\":\"above\",\"required\":\"\",\"options\":[{\"errors\":[],\"max_options\":\"0\",\"label\":\"yes\",\"value\":\"yes\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"no\",\"value\":\"no\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"1\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"drawerDisabled\":\"\",\"field_label\":\"Have you had any previous treatment for the above?\",\"field_key\":\"have_you_had_any_previous_treatment_for_the_above_1504590163000\",\"id\":28,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"list\",\"element_templates\":[\"listradio\",\"input\"],\"old_classname\":\"list-radio\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":29,\"idAttribute\":\"id\",\"type\":\"textbox\",\"label\":\"Who\",\"key\":\"who_1504526513394\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"Who\",\"field_key\":\"who_1504526513394\",\"id\":29,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":30,\"idAttribute\":\"id\",\"type\":\"textbox\",\"label\":\"When\",\"key\":\"when_1590678268855\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"When\",\"field_key\":\"when_1590678268855\",\"id\":30,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":31,\"idAttribute\":\"id\",\"label\":\"How long did you see them?\",\"type\":\"textbox\",\"key\":\"how_long_did_you_see_them_1504526782043\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"How long did you see them?\",\"field_key\":\"how_long_did_you_see_them_1504526782043\",\"id\":31,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":32,\"idAttribute\":\"id\",\"label\":\"Are you currently on any medication? \",\"type\":\"listradio\",\"key\":\"are_you_currently_on_any_medication_1504590284139\",\"label_pos\":\"above\",\"required\":1,\"options\":[{\"errors\":[],\"max_options\":\"0\",\"label\":\"Yes\",\"value\":\"yes\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"No\",\"value\":\"no\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"1\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"drawerDisabled\":\"\",\"field_label\":\"Are you currently on any medication? \",\"field_key\":\"are_you_currently_on_any_medication_1504590284139\",\"id\":32,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"list\",\"element_templates\":[\"listradio\",\"input\"],\"old_classname\":\"list-radio\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":33,\"idAttribute\":\"id\",\"label\":\"table\",\"type\":\"html\",\"default\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"key\":\"table_1504526919276\",\"drawerDisabled\":\"\",\"field_label\":\"table\",\"field_key\":\"table_1504526919276\",\"id\":33,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"label_pos\":\"above\",\"parentType\":\"html\",\"element_templates\":[\"html\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":34,\"idAttribute\":\"id\",\"label\":\"Current Medications and Dosages:\",\"type\":\"textbox\",\"key\":\"current_medications_and_dosages_1611088632276\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"Current Medications and Dosages:\",\"field_key\":\"current_medications_and_dosages_1611088632276\",\"id\":34,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":35,\"idAttribute\":\"id\",\"label\":\"Do you see a Pain Management Doctor or taking any pain medication?\",\"type\":\"listradio\",\"key\":\"do_you_see_a_pain_management_doctor_or_taking_any_pain_medication_1504590370176\",\"label_pos\":\"above\",\"required\":\"\",\"options\":[{\"errors\":[],\"max_options\":\"0\",\"label\":\"Yes\",\"value\":\"yes\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"No\",\"value\":\"no\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"1\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"drawerDisabled\":\"\",\"field_label\":\"Do you see a Pain Management Doctor or taking any pain medication?\",\"field_key\":\"do_you_see_a_pain_management_doctor_or_taking_any_pain_medication_1504590370176\",\"id\":35,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"list\",\"element_templates\":[\"listradio\",\"input\"],\"old_classname\":\"list-radio\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":36,\"idAttribute\":\"id\",\"label\":\"Who\",\"type\":\"textbox\",\"key\":\"who_1504590439814\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"Who\",\"field_key\":\"who_1504590439814\",\"id\":36,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":37,\"idAttribute\":\"id\",\"label\":\"What pain medication are you on? \",\"type\":\"listselect\",\"key\":\"what_pain_medication_are_you_on_1504590808449\",\"label_pos\":\"above\",\"required\":\"\",\"options\":[{\"errors\":[],\"max_options\":\"0\",\"order\":\"0\",\"new\":\"\",\"options\":[],\"label\":\"None\",\"value\":\"none\",\"calc\":\"\",\"selected\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":\"1\"},{\"errors\":[],\"max_options\":\"0\",\"label\":\"Oxycotin (Oxycodone) \",\"value\":\"oxycotin-oxycodone\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"1\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"Percocet (Acetaminophen) \",\"value\":\"percocet-acetaminophen\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"2\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"Morphine\",\"value\":\"morphine\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"3\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"order\":\"4\",\"new\":\"\",\"options\":[],\"label\":\"Other\",\"value\":\"other\",\"calc\":\"\",\"selected\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"drawerDisabled\":\"\",\"field_label\":\"What pain medication are you on? \",\"field_key\":\"what_pain_medication_are_you_on_1504590808449\",\"id\":37,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"list\",\"element_templates\":[\"listselect\",\"input\"],\"old_classname\":\"list-select\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":38,\"idAttribute\":\"id\",\"label\":\"In the past, have you used illegal drugs or prescription medications for nonmedical reasons one or more times in the past?\",\"type\":\"listradio\",\"key\":\"in_the_past_have_you_used_illegal_drugs_or_prescription_medications_for_nonmedical_reasons_one_or_more_times_in_the_past_1504590881353\",\"label_pos\":\"above\",\"required\":\"\",\"options\":[{\"errors\":[],\"max_options\":\"0\",\"label\":\"Yes\",\"value\":\"yes\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"No\",\"value\":\"no\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"1\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"drawerDisabled\":\"\",\"field_label\":\"In the past, have you used illegal drugs or prescription medications for nonmedical reasons one or more times in the past?\",\"field_key\":\"in_the_past_have_you_used_illegal_drugs_or_prescription_medications_for_nonmedical_reasons_one_or_more_times_in_the_past_1504590881353\",\"id\":38,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"list\",\"element_templates\":[\"listradio\",\"input\"],\"old_classname\":\"list-radio\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":39,\"idAttribute\":\"id\",\"label\":\"What?\",\"type\":\"textbox\",\"key\":\"what_1504527233294\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"What?\",\"field_key\":\"what_1504527233294\",\"id\":39,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":40,\"idAttribute\":\"id\",\"label\":\" Last used\",\"type\":\"textbox\",\"key\":\"last_used_1504527253968\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\" Last used\",\"field_key\":\"last_used_1504527253968\",\"id\":40,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":41,\"idAttribute\":\"id\",\"label\":\"Have you ever been treated for substance abuse?\",\"type\":\"listradio\",\"key\":\"have_you_ever_been_treated_for_substance_abuse_1504590956958\",\"label_pos\":\"above\",\"required\":\"\",\"options\":[{\"errors\":[],\"max_options\":\"0\",\"label\":\"Yes\",\"value\":\"yes\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"No\",\"value\":\"no\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"1\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"drawerDisabled\":\"\",\"field_label\":\"Have you ever been treated for substance abuse?\",\"field_key\":\"have_you_ever_been_treated_for_substance_abuse_1504590956958\",\"id\":41,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"list\",\"element_templates\":[\"listradio\",\"input\"],\"old_classname\":\"list-radio\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":42,\"idAttribute\":\"id\",\"label\":\"What substance?\",\"type\":\"textbox\",\"key\":\"what_substance_1504527350113\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"What substance?\",\"field_key\":\"what_substance_1504527350113\",\"id\":42,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":43,\"idAttribute\":\"id\",\"label\":\"Where did you receive treatment?\",\"type\":\"textbox\",\"key\":\"where_did_you_receive_treatment_1504527370648\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"Where did you receive treatment?\",\"field_key\":\"where_did_you_receive_treatment_1504527370648\",\"id\":43,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":44,\"idAttribute\":\"id\",\"label\":\"How long ago did you last use?\",\"type\":\"textbox\",\"key\":\"how_long_ago_did_you_last_use_1504527393541\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"How long ago did you last use?\",\"field_key\":\"how_long_ago_did_you_last_use_1504527393541\",\"id\":44,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":45,\"idAttribute\":\"id\",\"label\":\"Have you thought about or attempted suicide in the last year?\",\"type\":\"listradio\",\"key\":\"have_you_thought_about_or_attempted_suicide_in_the_last_year_1504591008459\",\"label_pos\":\"above\",\"required\":\"\",\"options\":[{\"errors\":[],\"max_options\":\"0\",\"label\":\"Yes\",\"value\":\"yes\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"No\",\"value\":\"no\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"1\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"drawerDisabled\":\"\",\"field_label\":\"Have you thought about or attempted suicide in the last year?\",\"field_key\":\"have_you_thought_about_or_attempted_suicide_in_the_last_year_1504591008459\",\"id\":45,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"list\",\"element_templates\":[\"listradio\",\"input\"],\"old_classname\":\"list-radio\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":46,\"idAttribute\":\"id\",\"label\":\"How long ago?\",\"type\":\"textbox\",\"key\":\"how_long_ago_1504527485264\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"How long ago?\",\"field_key\":\"how_long_ago_1504527485264\",\"id\":46,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":47,\"idAttribute\":\"id\",\"label\":\"What was the outcome?\",\"type\":\"textbox\",\"key\":\"what_was_the_outcome_1504527498499\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"What was the outcome?\",\"field_key\":\"what_was_the_outcome_1504527498499\",\"id\":47,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":48,\"idAttribute\":\"id\",\"label\":\"Were you sent to the hospital?\",\"type\":\"listradio\",\"key\":\"were_you_sent_to_the_hospital_1603902974632\",\"label_pos\":\"above\",\"required\":\"\",\"options\":[{\"errors\":[],\"max_options\":\"0\",\"label\":\"Yes what hospital?\\t\",\"value\":\"yes-what-hospital\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"No\",\"value\":\"no\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"1\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"drawerDisabled\":\"\",\"field_label\":\"Were you sent to the hospital?\",\"field_key\":\"were_you_sent_to_the_hospital_1603902974632\",\"id\":48,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"list\",\"element_templates\":[\"listradio\",\"input\"],\"old_classname\":\"list-radio\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":49,\"idAttribute\":\"id\",\"label\":\"Have you ever attempted or harmed others?\",\"type\":\"listradio\",\"key\":\"have_you_ever_attempted_or_harmed_others_1504591117928\",\"label_pos\":\"above\",\"required\":\"\",\"options\":[{\"errors\":[],\"max_options\":\"0\",\"label\":\"Yes\",\"value\":\"yes\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"No\",\"value\":\"no\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"1\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"drawerDisabled\":\"\",\"field_label\":\"Have you ever attempted or harmed others?\",\"field_key\":\"have_you_ever_attempted_or_harmed_others_1504591117928\",\"id\":49,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"list\",\"element_templates\":[\"listradio\",\"input\"],\"old_classname\":\"list-radio\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":50,\"idAttribute\":\"id\",\"label\":\"How did you harm them?\",\"type\":\"textbox\",\"key\":\"how_did_you_harm_them_1504527641740\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"How did you harm them?\",\"field_key\":\"how_did_you_harm_them_1504527641740\",\"id\":50,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":51,\"idAttribute\":\"id\",\"label\":\"Do you have pending charges? \",\"type\":\"listradio\",\"key\":\"do_you_have_pending_charges_1504591161463\",\"label_pos\":\"above\",\"required\":\"\",\"options\":[{\"errors\":[],\"max_options\":\"0\",\"label\":\"Yes\",\"value\":\"yes\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"No\",\"value\":\"no\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"1\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"drawerDisabled\":\"\",\"field_label\":\"Do you have pending charges? \",\"field_key\":\"do_you_have_pending_charges_1504591161463\",\"id\":51,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"list\",\"element_templates\":[\"listradio\",\"input\"],\"old_classname\":\"list-radio\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":52,\"idAttribute\":\"id\",\"label\":\"Were you arrested? \",\"type\":\"listradio\",\"key\":\"were_you_arrested_1603903028195\",\"label_pos\":\"above\",\"required\":\"\",\"options\":[{\"errors\":[],\"max_options\":\"0\",\"label\":\"Yes\",\"value\":\"yes\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"No\",\"value\":\"no\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"1\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"drawerDisabled\":\"\",\"field_label\":\"Were you arrested? \",\"field_key\":\"were_you_arrested_1603903028195\",\"id\":52,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"list\",\"element_templates\":[\"listradio\",\"input\"],\"old_classname\":\"list-radio\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":53,\"idAttribute\":\"id\",\"label\":\"Have you ever been admitted to a hospital \\\/ outpatient or an inpatient treatment center?\",\"type\":\"listradio\",\"key\":\"have_you_ever_been_admitted_to_a_hospital_outpatient_or_an_inpatient_treatment_center_1504591201312\",\"label_pos\":\"above\",\"required\":\"\",\"options\":[{\"errors\":[],\"max_options\":\"0\",\"label\":\"Yes\",\"value\":\"yes\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"No\",\"value\":\"no\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"1\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"drawerDisabled\":\"\",\"field_label\":\"Have you ever been admitted to a hospital \\\/ outpatient or an inpatient treatment center?\",\"field_key\":\"have_you_ever_been_admitted_to_a_hospital_outpatient_or_an_inpatient_treatment_center_1504591201312\",\"id\":53,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"list\",\"element_templates\":[\"listradio\",\"input\"],\"old_classname\":\"list-radio\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":54,\"idAttribute\":\"id\",\"label\":\"When?\",\"type\":\"textbox\",\"key\":\"when_1504527781682\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"When?\",\"field_key\":\"when_1504527781682\",\"id\":54,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":55,\"idAttribute\":\"id\",\"label\":\"Where? \",\"type\":\"textbox\",\"key\":\"where_1504527799799\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"Where? \",\"field_key\":\"where_1504527799799\",\"id\":55,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":56,\"idAttribute\":\"id\",\"label\":\"How long? \",\"type\":\"textbox\",\"key\":\"how_long_1504527819582\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"How long? \",\"field_key\":\"how_long_1504527819582\",\"id\":56,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":57,\"idAttribute\":\"id\",\"label\":\"Insurance Provider\",\"type\":\"textbox\",\"key\":\"insurance_provider_1590678213166\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"Insurance Provider\",\"field_key\":\"insurance_provider_1590678213166\",\"id\":57,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":58,\"idAttribute\":\"id\",\"label\":\"Primary Insurance\",\"type\":\"listselect\",\"key\":\"primary_insurance_1603903045326\",\"label_pos\":\"above\",\"required\":\"\",\"options\":[{\"errors\":[],\"max_options\":\"0\",\"order\":\"0\",\"new\":\"\",\"options\":[],\"label\":\"\",\"value\":\"\",\"calc\":\"\",\"selected\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"BCBS\",\"value\":\"bcbs\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"1\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"Cigna\",\"value\":\"cigna\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"2\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"Aetna\",\"value\":\"aetna\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"3\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"order\":\"4\",\"new\":\"\",\"options\":[],\"label\":\"Medicare\",\"value\":\"medicare\",\"calc\":\"\",\"selected\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"order\":\"5\",\"new\":\"\",\"options\":[],\"label\":\"Tircare \",\"value\":\"tircare\",\"calc\":\"\",\"selected\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"drawerDisabled\":\"\",\"field_label\":\"Primary Insurance\",\"field_key\":\"primary_insurance_1603903045326\",\"id\":58,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"list\",\"element_templates\":[\"listselect\",\"input\"],\"old_classname\":\"list-select\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":59,\"idAttribute\":\"id\",\"label\":\"Member ID\",\"type\":\"textbox\",\"key\":\"member_id_1504527955374\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"Member ID\",\"field_key\":\"member_id_1504527955374\",\"id\":59,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":60,\"idAttribute\":\"id\",\"label\":\"Group Number\",\"type\":\"textbox\",\"key\":\"group_number_1504527978834\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"Group Number\",\"field_key\":\"group_number_1504527978834\",\"id\":60,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":61,\"idAttribute\":\"id\",\"label\":\"Subscriber\",\"type\":\"textbox\",\"key\":\"subscriber_1504527990235\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"Subscriber\",\"field_key\":\"subscriber_1504527990235\",\"id\":61,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":62,\"idAttribute\":\"id\",\"label\":\"Subscriber D.O.B\",\"type\":\"date\",\"key\":\"subscriber_d_o_b_1504528037333\",\"label_pos\":\"above\",\"required\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"manual_key\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"date_default\":\"\",\"date_format\":\"\",\"year_range_start\":\"\",\"year_range_end\":\"\",\"drawerDisabled\":\"\",\"placeholder\":\"\",\"date_mode\":\"date_only\",\"hours_24\":0,\"minute_increment\":5,\"field_label\":\"Subscriber D.O.B\",\"field_key\":\"subscriber_d_o_b_1504528037333\",\"id\":62,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"date\",\"element_templates\":[\"date\",\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":63,\"idAttribute\":\"id\",\"label\":\"Address\",\"type\":\"address\",\"key\":\"address_1504528047594\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"custom_name_attribute\":\"address\",\"personally_identifiable\":1,\"value\":\"\",\"field_label\":\"Address\",\"field_key\":\"address_1504528047594\",\"id\":63,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"address\",\"element_templates\":[\"address\",\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":64,\"idAttribute\":\"id\",\"label\":\"Phone\",\"type\":\"phone\",\"key\":\"phone_1504528055935\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"custom_name_attribute\":\"phone\",\"personally_identifiable\":1,\"value\":\"\",\"field_label\":\"Phone\",\"field_key\":\"phone_1504528055935\",\"id\":64,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"tel\",\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":65,\"idAttribute\":\"id\",\"label\":\"Relation\",\"type\":\"textbox\",\"key\":\"relation_1504528122707\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"Relation\",\"field_key\":\"relation_1504528122707\",\"id\":65,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":66,\"idAttribute\":\"id\",\"label\":\"Insurance Benefits number (on back of card)\",\"type\":\"textbox\",\"key\":\"insurance_benefits_number_on_back_of_card_1602605363500\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"Insurance Benefits number (on back of card)\",\"field_key\":\"insurance_benefits_number_on_back_of_card_1602605363500\",\"id\":66,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":67,\"idAttribute\":\"id\",\"label\":\"Secondary Insurance\",\"type\":\"listselect\",\"key\":\"secondary_insurance_1504591395368\",\"label_pos\":\"above\",\"required\":\"\",\"options\":[{\"errors\":[],\"max_options\":\"0\",\"order\":\"0\",\"new\":\"\",\"options\":[],\"label\":\"No Secondary \",\"value\":\"no-secondary\",\"calc\":\"\",\"selected\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"BCBS \",\"value\":\"bcbs\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"1\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\"Cigna\",\"value\":\"cigna\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"2\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"label\":\" Aetna \",\"value\":\"aetna\",\"calc\":\"\",\"selected\":\"0\",\"order\":\"3\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"order\":\"4\",\"new\":\"\",\"options\":[],\"label\":\"Medicare\",\"value\":\"medicare\",\"calc\":\"\",\"selected\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"order\":\"5\",\"new\":\"\",\"options\":[],\"label\":\"Tricare\",\"value\":\"tricare\",\"calc\":\"\",\"selected\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":\"0\",\"order\":\"6\",\"new\":\"\",\"options\":[],\"label\":\"United \",\"value\":\"united \",\"calc\":\"\",\"selected\":\"0\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}},\"manual_value\":\"1\"}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"drawerDisabled\":\"\",\"field_label\":\"Secondary Insurance\",\"field_key\":\"secondary_insurance_1504591395368\",\"id\":67,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"list\",\"element_templates\":[\"listselect\",\"input\"],\"old_classname\":\"list-select\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":68,\"idAttribute\":\"id\",\"label\":\"Member ID\",\"type\":\"textbox\",\"key\":\"member_id_1504528357332\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"Member ID\",\"field_key\":\"member_id_1504528357332\",\"id\":68,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":69,\"idAttribute\":\"id\",\"label\":\"Group Number \",\"type\":\"textbox\",\"key\":\"group_number_1504528345888\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"Group Number \",\"field_key\":\"group_number_1504528345888\",\"id\":69,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":70,\"idAttribute\":\"id\",\"label\":\"Subscriber\",\"type\":\"textbox\",\"key\":\"subscriber_1504528351913\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"Subscriber\",\"field_key\":\"subscriber_1504528351913\",\"id\":70,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":71,\"idAttribute\":\"id\",\"label\":\"Subscriber D.O.B \",\"type\":\"date\",\"key\":\"subscriber_d_o_b_1504528341915\",\"label_pos\":\"above\",\"required\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"manual_key\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"date_default\":\"\",\"date_format\":\"\",\"year_range_start\":\"\",\"year_range_end\":\"\",\"drawerDisabled\":\"\",\"placeholder\":\"\",\"date_mode\":\"date_only\",\"hours_24\":0,\"minute_increment\":5,\"field_label\":\"Subscriber D.O.B \",\"field_key\":\"subscriber_d_o_b_1504528341915\",\"id\":71,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"date\",\"element_templates\":[\"date\",\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":72,\"idAttribute\":\"id\",\"label\":\"Address \",\"type\":\"address\",\"key\":\"address_1504528336888\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"address\",\"personally_identifiable\":1,\"value\":\"\",\"field_label\":\"Address \",\"field_key\":\"address_1504528336888\",\"id\":72,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"address\",\"element_templates\":[\"address\",\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":73,\"idAttribute\":\"id\",\"label\":\"Phone \",\"type\":\"phone\",\"key\":\"phone_1504528333103\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"phone\",\"personally_identifiable\":1,\"value\":\"\",\"field_label\":\"Phone \",\"field_key\":\"phone_1504528333103\",\"id\":73,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"tel\",\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":74,\"idAttribute\":\"id\",\"label\":\"Relation\",\"type\":\"textbox\",\"key\":\"relation_1504528327965\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"Relation\",\"field_key\":\"relation_1504528327965\",\"id\":74,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":75,\"idAttribute\":\"id\",\"label\":\"Insurance Benefits number \",\"type\":\"textbox\",\"key\":\"insurance_benefits_number_1504528322278\",\"label_pos\":\"above\",\"required\":\"\",\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"drawerDisabled\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"field_label\":\"Insurance Benefits number \",\"field_key\":\"insurance_benefits_number_1504528322278\",\"id\":75,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":76,\"idAttribute\":\"id\",\"type\":\"submit\",\"label\":\"Submit\",\"processing_label\":\"Processing\",\"container_class\":\"\",\"element_class\":\"\",\"key\":\"submit_1504526045020\",\"drawerDisabled\":\"\",\"field_label\":\"Submit\",\"field_key\":\"submit_1504526045020\",\"id\":76,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"label_pos\":\"above\",\"parentType\":\"textbox\",\"element_templates\":[\"submit\",\"button\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap-no-label\"}];nfForms.push(form);<\/script>\n        \t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>New Patients Request Appointment > +1 443-354-1200<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"_links":{"self":[{"href":"https:\/\/mymentalhealthtms.com\/index.php\/wp-json\/wp\/v2\/pages\/546"}],"collection":[{"href":"https:\/\/mymentalhealthtms.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/mymentalhealthtms.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/mymentalhealthtms.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/mymentalhealthtms.com\/index.php\/wp-json\/wp\/v2\/comments?post=546"}],"version-history":[{"count":25,"href":"https:\/\/mymentalhealthtms.com\/index.php\/wp-json\/wp\/v2\/pages\/546\/revisions"}],"predecessor-version":[{"id":989266,"href":"https:\/\/mymentalhealthtms.com\/index.php\/wp-json\/wp\/v2\/pages\/546\/revisions\/989266"}],"wp:attachment":[{"href":"https:\/\/mymentalhealthtms.com\/index.php\/wp-json\/wp\/v2\/media?parent=546"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}