[{"id":"67","title":"Confidential Morbidity Form (#67)","status":"published","appearance_settings":null,"form_fields":{"fields":[{"index":1,"element":"section_break","attributes":{"id":"","class":""},"settings":{"label":"Provider Information","description":"","align":"left","conditional_logics":[]},"editor_options":{"title":"Section Break","icon_class":"icon-puzzle-piece","template":"sectionBreak"},"uniqElKey":"el_1570700891109"},{"index":0,"element":"input_name","attributes":{"name":"names","data-type":"name-element"},"settings":{"container_class":"","admin_field_label":"Name","conditional_logics":[]},"fields":{"first_name":{"element":"input_text","attributes":{"type":"text","name":"first_name","value":"","id":"","class":"","placeholder":""},"settings":{"container_class":"","label":"Physician's Name (First Name)","help_message":"","visible":true,"validation_rules":{"required":{"value":true,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"template":"inputText"}},"middle_name":{"element":"input_text","attributes":{"type":"text","name":"middle_name","value":"","id":"","class":"","placeholder":"","required":false},"settings":{"container_class":"","label":"Middle Name","help_message":"","error_message":"","visible":false,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"template":"inputText"}},"last_name":{"element":"input_text","attributes":{"type":"text","name":"last_name","value":"","id":"","class":"","placeholder":"","required":false},"settings":{"container_class":"","label":"Last Name","help_message":"","error_message":"","visible":true,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"template":"inputText"}}},"editor_options":{"title":"Name Fields","element":"name-fields","icon_class":"icon-user","template":"nameFields"},"uniqElKey":"el_1570700919333"},{"index":1,"element":"container","attributes":[],"settings":[],"columns":[{"fields":[{"index":30,"element":"phone","attributes":{"name":"phone","class":"","value":"","type":"tel","placeholder":""},"settings":{"container_class":"","placeholder":"","int_tel_number":"no","label":"Physician's  Phone Number","label_placement":"","help_message":"","admin_field_label":"","validation_rules":{"required":{"value":false,"message":"This field is required"},"valid_phone_number":{"value":false,"message":"Phone number is not valid"}},"conditional_logics":[]},"editor_options":{"title":"Phone Field","icon_class":"el-icon-phone-outline","template":"inputText"},"uniqElKey":"el_1570700962710"}]},{"fields":[{"index":30,"element":"phone","attributes":{"name":"phone_1","class":"","value":"","type":"tel","placeholder":""},"settings":{"container_class":"","placeholder":"","int_tel_number":"no","label":"Facility Phone","label_placement":"","help_message":"","admin_field_label":"","validation_rules":{"required":{"value":false,"message":"This field is required"},"valid_phone_number":{"value":false,"message":"Phone number is not valid"}},"conditional_logics":[]},"editor_options":{"title":"Phone Field","icon_class":"el-icon-phone-outline","template":"inputText"},"uniqElKey":"el_1570700969356"}]}],"editor_options":{"title":"Two Column Container","icon_class":"icon-columns"},"uniqElKey":"el_1570700960274"},{"index":4,"element":"address","attributes":{"id":"","class":"","name":"address1","data-type":"address-element"},"settings":{"label":"Facility Address","admin_field_label":"","conditional_logics":[]},"fields":{"address_line_1":{"element":"input_text","attributes":{"type":"text","name":"address_line_1","value":"","id":"","class":"","placeholder":""},"settings":{"container_class":"","label":"Address Line 1","admin_field_label":"","help_message":"","visible":true,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"template":"inputText"}},"address_line_2":{"element":"input_text","attributes":{"type":"text","name":"address_line_2","value":"","id":"","class":"","placeholder":""},"settings":{"container_class":"","label":"Address Line 2","admin_field_label":"","help_message":"","visible":true,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"template":"inputText"}},"city":{"element":"input_text","attributes":{"type":"text","name":"city","value":"","id":"","class":"","placeholder":""},"settings":{"container_class":"","label":"City","admin_field_label":"","help_message":"","error_message":"","visible":true,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"template":"inputText"}},"state":{"element":"input_text","attributes":{"type":"text","name":"state","value":"","id":"","class":"","placeholder":""},"settings":{"container_class":"","label":"State","admin_field_label":"","help_message":"","error_message":"","visible":true,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"template":"inputText"}},"zip":{"element":"input_text","attributes":{"type":"text","name":"zip","value":"","id":"","class":"","placeholder":"","required":false},"settings":{"container_class":"","label":"Zip Code","admin_field_label":"","help_message":"","error_message":"","visible":true,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"template":"inputText"}},"country":{"element":"select_country","attributes":{"name":"country","value":"","id":"","class":"","placeholder":"","required":false},"settings":{"container_class":"","label":"Country","admin_field_label":"","help_message":"","error_message":"","visible":true,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"country_list":{"active_list":"all","visible_list":[],"hidden_list":[]},"conditional_logics":[]},"options":{"BD":"Bangladesh","US":"US of America"},"editor_options":{"title":"Country List","element":"country-list","icon_class":"icon-text-width","template":"selectCountry"}}},"editor_options":{"title":"Address Fields","element":"address-fields","icon_class":"icon-credit-card","template":"addressFields"},"uniqElKey":"el_1570700990101"},{"index":1,"element":"section_break","attributes":{"id":"","class":""},"settings":{"label":"Patient Information","description":"","align":"left","conditional_logics":[]},"editor_options":{"title":"Section Break","icon_class":"icon-puzzle-piece","template":"sectionBreak"},"uniqElKey":"el_1570701000610"},{"index":0,"element":"input_name","attributes":{"name":"names_1","data-type":"name-element"},"settings":{"container_class":"","admin_field_label":"Patient Name","conditional_logics":[]},"fields":{"first_name":{"element":"input_text","attributes":{"type":"text","name":"first_name","value":"","id":"","class":"","placeholder":""},"settings":{"container_class":"","label":"Patient Name(First Name)","help_message":"","visible":true,"validation_rules":{"required":{"value":true,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"template":"inputText"}},"middle_name":{"element":"input_text","attributes":{"type":"text","name":"middle_name","value":"","id":"","class":"","placeholder":"","required":false},"settings":{"container_class":"","label":"Middle Name","help_message":"","error_message":"","visible":false,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"template":"inputText"}},"last_name":{"element":"input_text","attributes":{"type":"text","name":"last_name","value":"","id":"","class":"","placeholder":"","required":false},"settings":{"container_class":"","label":"Last Name","help_message":"","error_message":"","visible":true,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"template":"inputText"}}},"editor_options":{"title":"Name Fields","element":"name-fields","icon_class":"icon-user","template":"nameFields"},"uniqElKey":"el_1570701019944"},{"index":13,"element":"input_date","attributes":{"type":"text","name":"datetime","value":"","id":"","class":"","placeholder":""},"settings":{"container_class":"","label":"Date of Birth","admin_field_label":"","label_placement":"","date_format":"d\/m\/Y","help_message":"","is_time_enabled":true,"validation_rules":{"required":{"value":true,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"title":"Time & Date","icon_class":"icon-calendar-o","template":"inputText"},"uniqElKey":"el_1570701057536"},{"index":4,"element":"address","attributes":{"id":"","class":"","name":"address2","data-type":"address-element"},"settings":{"label":"Patient Address","admin_field_label":"","conditional_logics":{"type":"any","status":false,"conditions":[{"field":"","value":"","operator":""}]}},"fields":{"address_line_1":{"element":"input_text","attributes":{"type":"text","name":"address_line_1","value":"","id":"","class":"","placeholder":""},"settings":{"container_class":"","label":"Address Line 1","admin_field_label":"","help_message":"","visible":true,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"template":"inputText"}},"address_line_2":{"element":"input_text","attributes":{"type":"text","name":"address_line_2","value":"","id":"","class":"","placeholder":""},"settings":{"container_class":"","label":"Address Line 2","admin_field_label":"","help_message":"","visible":true,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"template":"inputText"}},"city":{"element":"input_text","attributes":{"type":"text","name":"city","value":"","id":"","class":"","placeholder":""},"settings":{"container_class":"","label":"City","admin_field_label":"","help_message":"","error_message":"","visible":true,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"template":"inputText"}},"state":{"element":"input_text","attributes":{"type":"text","name":"state","value":"","id":"","class":"","placeholder":""},"settings":{"container_class":"","label":"State","admin_field_label":"","help_message":"","error_message":"","visible":true,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"template":"inputText"}},"zip":{"element":"input_text","attributes":{"type":"text","name":"zip","value":"","id":"","class":"","placeholder":"","required":false},"settings":{"container_class":"","label":"Zip Code","admin_field_label":"","help_message":"","error_message":"","visible":true,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"template":"inputText"}},"country":{"element":"select_country","attributes":{"name":"country","value":"","id":"","class":"","placeholder":"","required":false},"settings":{"container_class":"","label":"Country","admin_field_label":"","help_message":"","error_message":"","visible":true,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"country_list":{"active_list":"all","visible_list":[],"hidden_list":[]},"conditional_logics":[]},"options":{"BD":"Bangladesh","US":"US of America"},"editor_options":{"title":"Country List","element":"country-list","icon_class":"icon-text-width","template":"selectCountry"}}},"editor_options":{"title":"Address Fields","element":"address-fields","icon_class":"icon-credit-card","template":"addressFields"},"uniqElKey":"el_1570701078768"},{"index":1,"element":"container","attributes":[],"settings":[],"columns":[{"fields":[{"index":1,"element":"input_email","attributes":{"type":"email","name":"email","value":"","id":"","class":"","placeholder":""},"settings":{"container_class":"","label":"Patient Email","label_placement":"","help_message":"","admin_field_label":"","validation_rules":{"required":{"value":false,"message":"This field is required"},"email":{"value":true,"message":"This field must contain a valid email"}},"conditional_logics":[]},"editor_options":{"title":"Email Address","icon_class":"icon-envelope-o","template":"inputText"},"uniqElKey":"el_1570701100489"}]},{"fields":[{"index":30,"element":"phone","attributes":{"name":"phone_2","class":"","value":"","type":"tel","placeholder":""},"settings":{"container_class":"","placeholder":"","int_tel_number":"no","label":"Patient Phone","label_placement":"","help_message":"","admin_field_label":"","validation_rules":{"required":{"value":false,"message":"This field is required"},"valid_phone_number":{"value":false,"message":"Phone number is not valid"}},"conditional_logics":[]},"editor_options":{"title":"Phone Field","icon_class":"el-icon-phone-outline","template":"inputText"},"uniqElKey":"el_1570701109151"}]}],"editor_options":{"title":"Two Column Container","icon_class":"icon-columns"},"uniqElKey":"el_1570701096584"},{"index":1,"element":"container","attributes":[],"settings":[],"columns":[{"fields":[{"index":8,"element":"input_radio","attributes":{"type":"radio","name":"input_radio","value":""},"settings":{"container_class":"","label":"Race","admin_field_label":"","label_placement":"","display_type":"","help_message":"","validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"options":{"White":"White","Black":"Black","Asian":"Asian","Native American":"Native American","Pacific Islander":"Pacific Islander","Other":"Other"},"editor_options":{"title":"Radio Button","icon_class":"icon-dot-circle-o","element":"input-radio","template":"inputRadio"},"uniqElKey":"el_1570701147479"}]},{"fields":[{"index":8,"element":"input_radio","attributes":{"type":"radio","name":"input_radio_1","value":""},"settings":{"container_class":"","label":"Ethnicity","admin_field_label":"","label_placement":"","display_type":"","help_message":"","validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"options":{"Hispanic":"Hispanic","Non-Hispanic":"Non-Hispanic"},"editor_options":{"title":"Radio Button","icon_class":"icon-dot-circle-o","element":"input-radio","template":"inputRadio"},"uniqElKey":"el_1570701210101"},{"index":2,"element":"input_text","attributes":{"type":"text","name":"input_text","value":"","class":"","placeholder":""},"settings":{"container_class":"","label":"Other (Race)","label_placement":"","admin_field_label":"","help_message":"","validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":{"type":"any","status":true,"conditions":[{"field":"input_radio","value":"Other","operator":"="}]}},"editor_options":{"title":"Simple Text","icon_class":"icon-text-width","template":"inputText"},"uniqElKey":"el_1570704399993"}]}],"editor_options":{"title":"Two Column Container","icon_class":"icon-columns"},"uniqElKey":"el_1570701138843"},{"index":1,"element":"container","attributes":[],"settings":[],"columns":[{"fields":[{"index":8,"element":"input_radio","attributes":{"type":"radio","name":"input_radio_2","value":""},"settings":{"container_class":"","label":"Gender","admin_field_label":"","label_placement":"","display_type":"","help_message":"","validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"options":{"Male":"Male","Female":"Female","Transgender, Male-Female":"Transgender, Male-Female","Transgender, Female-Male":"Transgender, Female-Male"},"editor_options":{"title":"Radio Button","icon_class":"icon-dot-circle-o","element":"input-radio","template":"inputRadio"},"uniqElKey":"el_1570701289836"}]},{"fields":[{"index":2,"element":"input_text","attributes":{"type":"text","name":"input_text_1","value":"","class":"","placeholder":""},"settings":{"container_class":"","label":"Social Security Number","label_placement":"","admin_field_label":"","help_message":"","validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"title":"Simple Text","icon_class":"icon-text-width","template":"inputText"},"uniqElKey":"el_1570701320803"}]}],"editor_options":{"title":"Two Column Container","icon_class":"icon-columns"},"uniqElKey":"el_1570701274582"},{"index":3,"element":"custom_html","attributes":[],"settings":{"html_codes":"<p><span id=\"label72178383\" class=\"fsLabel\">Parent\/Guardian Name:<\/span><\/p>","conditional_logics":{"type":"any","status":false,"conditions":[{"field":"","value":"","operator":""}]}},"editor_options":{"title":"Custom HTML","icon_class":"icon-code","template":"customHTML"},"uniqElKey":"el_1570701987911"},{"index":1,"element":"container","attributes":[],"settings":[],"columns":[{"fields":[{"index":0,"element":"input_name","attributes":{"name":"names_2","data-type":"name-element"},"settings":{"container_class":"","admin_field_label":"Name","conditional_logics":[]},"fields":{"first_name":{"element":"input_text","attributes":{"type":"text","name":"first_name","value":"","id":"","class":"","placeholder":""},"settings":{"container_class":"","label":"First Name","help_message":"","visible":true,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"template":"inputText"}},"middle_name":{"element":"input_text","attributes":{"type":"text","name":"middle_name","value":"","id":"","class":"","placeholder":"","required":false},"settings":{"container_class":"","label":"Middle Name","help_message":"","error_message":"","visible":false,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"template":"inputText"}},"last_name":{"element":"input_text","attributes":{"type":"text","name":"last_name","value":"","id":"","class":"","placeholder":"","required":false},"settings":{"container_class":"","label":"Last Name","help_message":"","error_message":"","visible":true,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"template":"inputText"}}},"editor_options":{"title":"Name Fields","element":"name-fields","icon_class":"icon-user","template":"nameFields"},"uniqElKey":"el_1570701434879"}]},{"fields":[{"index":30,"element":"phone","attributes":{"name":"phone_3","class":"","value":"","type":"tel","placeholder":""},"settings":{"container_class":"","placeholder":"","int_tel_number":"no","label":"Parent\/Guardian Phone","label_placement":"","help_message":"","admin_field_label":"","validation_rules":{"required":{"value":false,"message":"This field is required"},"valid_phone_number":{"value":false,"message":"Phone number is not valid"}},"conditional_logics":[]},"editor_options":{"title":"Phone Field","icon_class":"el-icon-phone-outline","template":"inputText"},"uniqElKey":"el_1570701508786"}]}],"editor_options":{"title":"Two Column Container","icon_class":"icon-columns"},"uniqElKey":"el_1570701423376"},{"index":1,"element":"section_break","attributes":{"id":"","class":""},"settings":{"label":"Disease","description":"","align":"left","conditional_logics":[]},"editor_options":{"title":"Section Break","icon_class":"icon-puzzle-piece","template":"sectionBreak"},"uniqElKey":"el_1570701667839"},{"index":2,"element":"input_text","attributes":{"type":"text","name":"input_text_2","value":"","class":"","placeholder":""},"settings":{"container_class":"","label":"Disease or Condition Name","label_placement":"","admin_field_label":"","help_message":"","validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"title":"Simple Text","icon_class":"icon-text-width","template":"inputText"},"uniqElKey":"el_1570701686560"},{"index":1,"element":"container","attributes":[],"settings":[],"columns":[{"fields":[{"index":13,"element":"input_date","attributes":{"type":"text","name":"datetime_1","value":"","id":"","class":"","placeholder":""},"settings":{"container_class":"","label":"Admission Date","admin_field_label":"","label_placement":"","date_format":"d\/m\/Y","help_message":"","is_time_enabled":true,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"title":"Time & Date","icon_class":"icon-calendar-o","template":"inputText"},"uniqElKey":"el_1570701742849"}]},{"fields":[{"index":13,"element":"input_date","attributes":{"type":"text","name":"datetime_2","value":"","id":"","class":"","placeholder":""},"settings":{"container_class":"","label":"Onset Date","admin_field_label":"","label_placement":"","date_format":"d\/m\/Y","help_message":"","is_time_enabled":true,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"title":"Time & Date","icon_class":"icon-calendar-o","template":"inputText"},"uniqElKey":"el_1570701731895"}]}],"editor_options":{"title":"Two Column Container","icon_class":"icon-columns"},"uniqElKey":"el_1570701708987"},{"index":1,"element":"container","attributes":[],"settings":[],"columns":[{"fields":[{"index":13,"element":"input_date","attributes":{"type":"text","name":"datetime_3","value":"","id":"","class":"","placeholder":""},"settings":{"container_class":"","label":"Diagnosis Date","admin_field_label":"","label_placement":"","date_format":"d\/m\/Y","help_message":"","is_time_enabled":true,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"title":"Time & Date","icon_class":"icon-calendar-o","template":"inputText"},"uniqElKey":"el_1570701753303"}]},{"fields":[{"index":13,"element":"input_date","attributes":{"type":"text","name":"datetime_4","value":"","id":"","class":"","placeholder":""},"settings":{"container_class":"","label":"Discharge Date","admin_field_label":"","label_placement":"","date_format":"d\/m\/Y","help_message":"","is_time_enabled":true,"validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"title":"Time & Date","icon_class":"icon-calendar-o","template":"inputText"},"uniqElKey":"el_1570701765837"}]}],"editor_options":{"title":"Two Column Container","icon_class":"icon-columns"},"uniqElKey":"el_1570701710356"},{"index":3,"element":"textarea","attributes":{"name":"description","value":"","id":"","class":"","placeholder":"","rows":4,"cols":2},"settings":{"container_class":"","label":"Symptoms","admin_field_label":"","label_placement":"","help_message":"","validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"title":"Text Area","icon_class":"icon-paragraph","template":"inputTextarea"},"uniqElKey":"el_1570701783552"},{"index":1,"element":"container","attributes":[],"settings":[],"columns":[{"fields":[{"index":8,"element":"input_radio","attributes":{"type":"radio","name":"input_radio_3","value":""},"settings":{"container_class":"","label":"Was laboratory testing ordered?","admin_field_label":"","label_placement":"","display_type":"","help_message":"","validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"options":{"yes":"Yes","no":"No"},"editor_options":{"title":"Radio Button","icon_class":"icon-dot-circle-o","element":"input-radio","template":"inputRadio"},"uniqElKey":"el_1570701837595"}]},{"fields":[{"index":14,"element":"input_file","attributes":{"type":"file","name":"file-upload","value":"","id":"","class":""},"settings":{"container_class":"","label":"If yes, attach the results:","admin_field_label":"","label_placement":"top","btn_text":"Choose File","help_message":"","validation_rules":{"required":{"value":false,"message":"This field is required"},"max_file_size":{"value":1048576,"_valueFrom":"MB","message":"Maximum file size limit"},"max_file_count":{"value":1,"message":"Max file count"},"allowed_file_types":{"value":[],"message":"allowed_file_types"}},"conditional_logics":{"type":"any","status":true,"conditions":[{"field":"input_radio_3","value":"yes","operator":"="}]}},"editor_options":{"title":"File Upload","icon_class":"icon-upload","template":"inputFile"},"uniqElKey":"el_1570701843955"}]}],"editor_options":{"title":"Two Column Container","icon_class":"icon-columns"},"uniqElKey":"el_1570701834667"},{"index":1,"element":"container","attributes":[],"settings":[],"columns":[{"fields":[{"index":8,"element":"input_radio","attributes":{"type":"radio","name":"input_radio_4","value":""},"settings":{"container_class":"","label":"What the patient treated?","admin_field_label":"","label_placement":"","display_type":"","help_message":"","validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"options":{"yes":"Yes","no":"No"},"editor_options":{"title":"Radio Button","icon_class":"icon-dot-circle-o","element":"input-radio","template":"inputRadio"},"uniqElKey":"el_1570701837595"}]},{"fields":[{"index":14,"element":"input_file","attributes":{"type":"file","name":"file-upload_1","value":"","id":"","class":""},"settings":{"container_class":"","label":"If yes, provide treatment details:","admin_field_label":"","label_placement":"top","btn_text":"Choose File","help_message":"","validation_rules":{"required":{"value":false,"message":"This field is required"},"max_file_size":{"value":1048576,"_valueFrom":"MB","message":"Maximum file size limit"},"max_file_count":{"value":1,"message":"Max file count"},"allowed_file_types":{"value":[],"message":"allowed_file_types"}},"conditional_logics":{"type":"any","status":true,"conditions":[{"field":"input_radio_4","value":"yes","operator":"="}]}},"editor_options":{"title":"File Upload","icon_class":"icon-upload","template":"inputFile"},"uniqElKey":"el_1570701843955"}]}],"editor_options":{"title":"Two Column Container","icon_class":"icon-columns"},"uniqElKey":"el_1570701869808"},{"index":3,"element":"textarea","attributes":{"name":"description_1","value":"","id":"","class":"","placeholder":"","rows":4,"cols":2},"settings":{"container_class":"","label":"Description of other illnesses\/treatments","admin_field_label":"","label_placement":"","help_message":"","validation_rules":{"required":{"value":false,"message":"This field is required"}},"conditional_logics":[]},"editor_options":{"title":"Text Area","icon_class":"icon-paragraph","template":"inputTextarea"},"uniqElKey":"el_1570701933662"}],"submitButton":{"uniqElKey":"el_1524065200616","element":"button","attributes":{"type":"submit","class":""},"settings":{"align":"center","button_style":"default","container_class":"","help_message":"","background_color":"#409EFF","button_size":"sm","color":"#ffffff","button_ui":{"type":"default","text":"Submit Form","img_url":""},"normal_styles":[],"hover_styles":[],"current_state":"normal_styles"},"editor_options":{"title":"Submit Button"}}},"has_payment":"0","type":"form","conditions":null,"created_by":"1","created_at":"2019-11-16 11:40:22","updated_at":"2019-11-16 11:40:22","metas":[{"meta_key":"formSettings","value":"{\"confirmation\":{\"redirectTo\":\"samePage\",\"messageToShow\":\"Thank you for your message. We will get in touch with you shortly\",\"customPage\":null,\"samePageFormBehavior\":\"hide_form\",\"customUrl\":null},\"restrictions\":{\"limitNumberOfEntries\":{\"enabled\":false,\"numberOfEntries\":null,\"period\":\"total\",\"limitReachedMsg\":null},\"scheduleForm\":{\"enabled\":false,\"start\":null,\"end\":null,\"pendingMsg\":\"Form submission is not started yet.\",\"expiredMsg\":\"Form submission is now closed.\"},\"requireLogin\":{\"enabled\":false,\"requireLoginMsg\":null},\"denyEmptySubmission\":{\"enabled\":false,\"message\":\"Sorry, you cannot submit an empty form. Lets hear what you wanna say.\"}},\"layout\":{\"labelPlacement\":\"top\",\"helpMessagePlacement\":\"with_label\",\"errorMessagePlacement\":\"inline\"}}"},{"meta_key":"notifications","value":"{\"name\":\"Admin Notification Email\",\"sendTo\":{\"type\":\"email\",\"email\":\"{wp.admin_email}\",\"field\":\"email\",\"routing\":[{\"email\":null,\"field\":null,\"operator\":\"=\",\"value\":null}]},\"fromName\":\"\",\"fromEmail\":\"\",\"replyTo\":\"\",\"bcc\":\"\",\"subject\":\"[{inputs.names}] New Form Submission\",\"message\":\"<p>{all_data}<\\\/p>\\n<p>This form submitted at: {embed_post.permalink}<\\\/p>\",\"conditionals\":{\"status\":false,\"type\":\"all\",\"conditions\":[{\"field\":null,\"operator\":\"=\",\"value\":null}]},\"enabled\":false,\"email_template\":\"\"}"},{"meta_key":"ffs_default","value":""},{"meta_key":"_ff_form_styles","value":"[]"}]}]