{"id":10701,"date":"2021-08-20T02:13:27","date_gmt":"2021-08-20T02:13:27","guid":{"rendered":"https:\/\/centraldcclinic.com\/?page_id=10701"},"modified":"2026-04-15T11:04:48","modified_gmt":"2026-04-15T11:04:48","slug":"cif","status":"publish","type":"page","link":"https:\/\/moremiinitiative.org\/pavilion\/cif\/","title":{"rendered":"CASE INVESTIGATIONS FORM &#8211; COVID 19 (2019-nCoV)"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-11328\" src=\"https:\/\/moremiinitiative.org\/pavilion\/wp-content\/uploads\/2021\/08\/Rapid-Testing-1.jpeg\" alt=\"\" width=\"640\" height=\"797\" srcset=\"https:\/\/moremiinitiative.org\/pavilion\/wp-content\/uploads\/2021\/08\/Rapid-Testing-1.jpeg 640w, https:\/\/moremiinitiative.org\/pavilion\/wp-content\/uploads\/2021\/08\/Rapid-Testing-1-241x300.jpeg 241w\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" \/><div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_8_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_case620d79709\" >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">CASE INVESTIGATIONS FORM - COVID 19 (2019-nCoV)<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"8\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_8\" id=\"frm_hide_fields_8\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"case620d79709\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_8\" name=\"frm_submit_entry_8\" value=\"531b66f927\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/pavilion\/wp-json\/wp\/v2\/pages\/10701\" \/><div id=\"frm_field_213_container\" class=\"frm_form_field frm_section_heading form-field \">\n<h3 class=\"frm_pos_top\">Personal Information<\/h3>\n<div id=\"frm_desc_field_bm0nna57c4820baeaac12c9c2\" class=\"frm_description frm_section_spacing\">You are important to us. Please help us serve you better by taking a few minutes to express your satisfaction on our services rendered to you today.<\/div>\n\n<div id=\"frm_field_214_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <div  id=\"field_i3qin_label\" class=\"frm_primary_label\">Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <fieldset aria-labelledby=\"field_i3qin_label\">\n\t<legend class=\"frm_screen_reader frm_hidden\">\n\t\tName\t<\/legend>\n\n\t<div  class=\"frm_combo_inputs_container\" id=\"frm_combo_inputs_container_214\" data-name-layout=\"first_last\">\n\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_214-first_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-first  frm6\"\n\t\t\t\tdata-sub-field-name=\"first\"\n\t\t\t>\n\t\t\t\t<label for=\"field_i3qin_first\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tFirst\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_i3qin_first\" value=\"\" name=\"item_meta[214][first]\" autocomplete=\"given-name\" data-sectionid=\"213\" data-reqmsg=\"Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Name is invalid\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_214_first_desc\">First<\/div>\t\t\t<\/div>\n\t\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_214-last_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-last  frm6\"\n\t\t\t\tdata-sub-field-name=\"last\"\n\t\t\t>\n\t\t\t\t<label for=\"field_i3qin_last\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tLast\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_i3qin_last\" value=\"\" name=\"item_meta[214][last]\" autocomplete=\"family-name\" data-sectionid=\"213\" data-reqmsg=\"Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Name is invalid\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_214_last_desc\">Last<\/div>\t\t\t<\/div>\n\t\t\t\t<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_215_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_t39vr\" id=\"field_t39vr_label\" class=\"frm_primary_label\">Address:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_t39vr\" name=\"item_meta[215]\" value=\"\"  data-sectionid=\"213\" data-reqmsg=\"Address: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_216_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_52gx\" id=\"field_52gx_label\" class=\"frm_primary_label\">Date\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_52gx\" name=\"item_meta[216]\" value=\"\"  data-sectionid=\"213\" maxlength=\"10\" data-reqmsg=\"Date cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_217_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_6ge3o\" id=\"field_6ge3o_label\" class=\"frm_primary_label\">Date of Birth\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_6ge3o\" name=\"item_meta[217]\" value=\"\"  data-sectionid=\"213\" maxlength=\"10\" data-reqmsg=\"Date of Birth cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_218_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_4ctfb\" id=\"field_4ctfb_label\" class=\"frm_primary_label\">Age\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_4ctfb\" name=\"item_meta[218]\" value=\"\"  data-sectionid=\"213\" data-reqmsg=\"Age cannot be blank.\" aria-required=\"true\" data-invmsg=\"Number is invalid\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_219_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth\">\r\n    <label for=\"field_pu5ly\" id=\"field_pu5ly_label\" class=\"frm_primary_label\">If Child is greater than one year, state number of months\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_pu5ly\" name=\"item_meta[219]\" value=\"\"  data-sectionid=\"213\" data-invmsg=\"Number is invalid\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_220_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth\">\r\n    <label for=\"field_q0af8\" id=\"field_q0af8_label\" class=\"frm_primary_label\">If Child is less than a month, state in days\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_q0af8\" name=\"item_meta[220]\" value=\"\"  data-sectionid=\"213\" data-invmsg=\"Number is invalid\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_221_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_n6cu\" id=\"field_n6cu_label\" class=\"frm_primary_label\">Sex\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[221]\" id=\"field_n6cu\"  data-sectionid=\"213\" data-placeholder=\"Select an option\"  data-frmval=\"Male\" data-reqmsg=\"Sex cannot be blank.\" aria-required=\"true\" data-invmsg=\"Sex is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Male\" selected='selected'>Male<\/option><option  value=\"Female\">Female<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_222_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\n    <label for=\"field_qmvgj\" id=\"field_qmvgj_label\" class=\"frm_primary_label\">Phone\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n    <\/label>\n    <input type=\"tel\" id=\"field_qmvgj\" name=\"item_meta[222]\" value=\"\"  data-sectionid=\"213\" data-reqmsg=\"Phone cannot be blank.\" aria-required=\"true\" data-invmsg=\"Phone is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\n    \n    \n<\/div>\n<div id=\"frm_field_223_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth\">\n    <label for=\"field_h398j\" id=\"field_h398j_label\" class=\"frm_primary_label\">Email\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n    <\/label>\n    <input type=\"email\" id=\"field_h398j\" name=\"item_meta[223]\" value=\"\"  data-sectionid=\"213\" data-invmsg=\"Email is invalid\" aria-invalid=\"false\"  \/>\n    \n    \n<\/div>\n<\/div>\n<div id=\"frm_field_225_container\" class=\"frm_form_field frm_section_heading form-field  frm_half\">\n<h3 class=\"frm_pos_top frm_section_spacing\">Patient symptoms <\/h3>\n\n\n<div id=\"frm_field_226_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half vertical_radio frm_other_container\">\r\n    <div  id=\"field_oa0ml6fbbd725ea_label\" class=\"frm_primary_label\">(check all reported symptoms)\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_oa0ml6fbbd725ea_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_226-225-0\">\t\t\t<label  for=\"field_oa0ml6fbbd725ea-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[226][]\" id=\"field_oa0ml6fbbd725ea-0\" value=\"History of fever\/chills\"  data-sectionid=\"225\" data-frmlimit=\"8\"  data-reqmsg=\"(check all reported symptoms) cannot be blank.\" data-invmsg=\"(check all reported symptoms) is invalid\"   aria-required=\"true\"  \/> History of fever\/chills<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_226-225-1\">\t\t\t<label  for=\"field_oa0ml6fbbd725ea-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[226][]\" id=\"field_oa0ml6fbbd725ea-1\" value=\"General weakness\"  data-sectionid=\"225\" data-frmlimit=\"8\"  data-reqmsg=\"(check all reported symptoms) cannot be blank.\" data-invmsg=\"(check all reported symptoms) is invalid\"   \/> General weakness<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_226-225-2\">\t\t\t<label  for=\"field_oa0ml6fbbd725ea-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[226][]\" id=\"field_oa0ml6fbbd725ea-2\" value=\"Cough\"  data-sectionid=\"225\" data-frmlimit=\"8\"  data-reqmsg=\"(check all reported symptoms) cannot be blank.\" data-invmsg=\"(check all reported symptoms) is invalid\"   \/> Cough<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_226-225-3\">\t\t\t<label  for=\"field_oa0ml6fbbd725ea-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[226][]\" id=\"field_oa0ml6fbbd725ea-3\" value=\"Runny nose\"  data-sectionid=\"225\" data-frmlimit=\"8\"  data-reqmsg=\"(check all reported symptoms) cannot be blank.\" data-invmsg=\"(check all reported symptoms) is invalid\"   \/> Runny nose<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_226-225-4\">\t\t\t<label  for=\"field_oa0ml6fbbd725ea-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[226][]\" id=\"field_oa0ml6fbbd725ea-4\" value=\"Shortness of breath\"  data-sectionid=\"225\" data-frmlimit=\"8\"  data-reqmsg=\"(check all reported symptoms) cannot be blank.\" data-invmsg=\"(check all reported symptoms) is invalid\"   \/> Shortness of breath<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_226-225-6\">\t\t\t<label  for=\"field_oa0ml6fbbd725ea-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[226][]\" id=\"field_oa0ml6fbbd725ea-6\" value=\"Headache\"  data-sectionid=\"225\" data-frmlimit=\"8\"  data-reqmsg=\"(check all reported symptoms) cannot be blank.\" data-invmsg=\"(check all reported symptoms) is invalid\"   \/> Headache<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_226-225-7\">\t\t\t<label  for=\"field_oa0ml6fbbd725ea-7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[226][]\" id=\"field_oa0ml6fbbd725ea-7\" value=\"Sore throat\"  data-sectionid=\"225\" data-frmlimit=\"8\"  data-reqmsg=\"(check all reported symptoms) cannot be blank.\" data-invmsg=\"(check all reported symptoms) is invalid\"   \/> Sore throat<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_226-225-other_8\">\t\t\t<label  for=\"field_oa0ml6fbbd725ea-other_8\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[226][other_8]\" id=\"field_oa0ml6fbbd725ea-other_8\" value=\"Other\"  data-sectionid=\"225\" data-frmlimit=\"8\"  data-reqmsg=\"(check all reported symptoms) cannot be blank.\" data-invmsg=\"(check all reported symptoms) is invalid\"   \/> Other<\/label><label for=\"field_oa0ml6fbbd725ea-other_8-otext\" class=\"frm_screen_reader frm_hidden\">Other<\/label><input type=\"text\" id=\"field_oa0ml6fbbd725ea-other_8-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][226][other_8]\" value=\"\" \/><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_228_container\" class=\"frm_form_field frm_section_heading form-field  frm_half\">\n<h3 class=\"frm_pos_top frm_section_spacing\">Reason for Testing<\/h3>\n\n\n<div id=\"frm_field_229_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half vertical_radio frm_other_container\">\r\n    <div  id=\"field_2t8ry5a4bdf162b_label\" class=\"frm_primary_label\">Let us know why you want to take the test\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_2t8ry5a4bdf162b_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_229-228-0\">\t\t\t<label  for=\"field_2t8ry5a4bdf162b-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[229][]\" id=\"field_2t8ry5a4bdf162b-0\" value=\"Having Symptoms\"  data-sectionid=\"228\" data-frmlimit=\"7\"  data-reqmsg=\"Let us know why you want to take the test cannot be blank.\" data-invmsg=\"Let us know why you want to take the test is invalid\"   aria-required=\"true\"  \/> Having Symptoms<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_229-228-1\">\t\t\t<label  for=\"field_2t8ry5a4bdf162b-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[229][]\" id=\"field_2t8ry5a4bdf162b-1\" value=\"Had Contact With a COVID Patient\"  data-sectionid=\"228\" data-frmlimit=\"7\"  data-reqmsg=\"Let us know why you want to take the test cannot be blank.\" data-invmsg=\"Let us know why you want to take the test is invalid\"   \/> Had Contact With a COVID Patient<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_229-228-2\">\t\t\t<label  for=\"field_2t8ry5a4bdf162b-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[229][]\" id=\"field_2t8ry5a4bdf162b-2\" value=\"Having Employment\"  data-sectionid=\"228\" data-frmlimit=\"7\"  data-reqmsg=\"Let us know why you want to take the test cannot be blank.\" data-invmsg=\"Let us know why you want to take the test is invalid\"   \/> Having Employment<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_229-228-3\">\t\t\t<label  for=\"field_2t8ry5a4bdf162b-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[229][]\" id=\"field_2t8ry5a4bdf162b-3\" value=\"On Request of My Employer\"  data-sectionid=\"228\" data-frmlimit=\"7\"  data-reqmsg=\"Let us know why you want to take the test cannot be blank.\" data-invmsg=\"Let us know why you want to take the test is invalid\"   \/> On Request of My Employer<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_229-228-4\">\t\t\t<label  for=\"field_2t8ry5a4bdf162b-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[229][]\" id=\"field_2t8ry5a4bdf162b-4\" value=\"Test After Treatment\"  data-sectionid=\"228\" data-frmlimit=\"7\"  data-reqmsg=\"Let us know why you want to take the test cannot be blank.\" data-invmsg=\"Let us know why you want to take the test is invalid\"   \/> Test After Treatment<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_229-228-5\">\t\t\t<label  for=\"field_2t8ry5a4bdf162b-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[229][]\" id=\"field_2t8ry5a4bdf162b-5\" value=\"Runny Nose\"  data-sectionid=\"228\" data-frmlimit=\"7\"  data-reqmsg=\"Let us know why you want to take the test cannot be blank.\" data-invmsg=\"Let us know why you want to take the test is invalid\"   \/> Runny Nose<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_229-228-other_6\">\t\t\t<label  for=\"field_2t8ry5a4bdf162b-other_6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[229][other_6]\" id=\"field_2t8ry5a4bdf162b-other_6\" value=\"Other\"  data-sectionid=\"228\" data-frmlimit=\"7\"  data-reqmsg=\"Let us know why you want to take the test cannot be blank.\" data-invmsg=\"Let us know why you want to take the test is invalid\"   \/> Other<\/label><label for=\"field_2t8ry5a4bdf162b-other_6-otext\" class=\"frm_screen_reader frm_hidden\">Other<\/label><input type=\"text\" id=\"field_2t8ry5a4bdf162b-other_6-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][229][other_6]\" value=\"\" \/><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_231_container\" class=\"frm_form_field frm_section_heading form-field  frm_half\">\n<h3 class=\"frm_pos_top frm_section_spacing\">Sampling Type:<\/h3>\n\n\n<div id=\"frm_field_232_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_1mwxa424599f704_label\" class=\"frm_primary_label\">How will your sample be taken\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_1mwxa424599f704_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_232-231-1\">\t\t\t<label  for=\"field_1mwxa424599f704-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[232][]\" id=\"field_1mwxa424599f704-1\" value=\"Nasopharyngeal Swab\"  data-sectionid=\"231\" data-frmlimit=\"1\"  data-reqmsg=\"How will your sample be taken cannot be blank.\" data-invmsg=\"How will your sample be taken is invalid\"   aria-required=\"true\"  \/> Nasopharyngeal Swab<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_234_container\">\n\t\t\t<label for=\"field_fpekf\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_fpekf\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[234]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"ealbWs8mc+VtbZMh+lgUeFhUbMLfvq9oUcLKk1c02UI=\" \/><div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"  >Submit<\/button>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>&nbsp;<\/p>\n","protected":false},"author":4,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-10701","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/moremiinitiative.org\/pavilion\/wp-json\/wp\/v2\/pages\/10701","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/moremiinitiative.org\/pavilion\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/moremiinitiative.org\/pavilion\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/moremiinitiative.org\/pavilion\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/moremiinitiative.org\/pavilion\/wp-json\/wp\/v2\/comments?post=10701"}],"version-history":[{"count":1,"href":"https:\/\/moremiinitiative.org\/pavilion\/wp-json\/wp\/v2\/pages\/10701\/revisions"}],"predecessor-version":[{"id":12614,"href":"https:\/\/moremiinitiative.org\/pavilion\/wp-json\/wp\/v2\/pages\/10701\/revisions\/12614"}],"wp:attachment":[{"href":"https:\/\/moremiinitiative.org\/pavilion\/wp-json\/wp\/v2\/media?parent=10701"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}