{"id":1885,"date":"2020-04-01T14:45:17","date_gmt":"2020-04-01T14:45:17","guid":{"rendered":"http:\/\/liversummit.com\/?page_id=1885"},"modified":"2020-04-01T14:45:20","modified_gmt":"2020-04-01T14:45:20","slug":"covid-hep-pk","status":"publish","type":"page","link":"http:\/\/liversummit.com\/index.php\/covid-hep-pk\/","title":{"rendered":"COVID-HEP.PK"},"content":{"rendered":"<div id=\"erf_form_container_1883\" class=\"erf-container erf-contact erf-label-top erf-layout-one-column erf-style-rounded-corner\">\n        \n    \n         \n                    <div class=\"erf-content-above\">\n                Contact us by filling out the form below.            <\/div>\n            <form method=\"post\" enctype=\"multipart\/form-data\" class=\"erf-form erf-front-form\" data-parsley-validate=\"\" novalidate=\"true\" data-erf-submission-id=\"0\" data-erf-form-id=\"1883\">\n                <div class=\"erf-form-html\" id=\"erf_form_1883\">\n                    <div class=\"rendered-form\">\n                        <div class=\"erf-header erf-element-width-12\"><h1  data-non-input='1' data-ref-label='ref-JwLlV8qc' data-ref-id='ref-woDa4vZE' class='' >Reporter Information<\/h1><\/div><div class=\"erf-text form-group field-text-1927236561 erf-element-width-12\"><label for=\"text-1927236561\" class=\"erf-text-label\">Name of Reporter<span class=\"erf-required\">*<\/span><\/label><input type='text' maxlength='50' required='required' class='form-control' name='text-1927236561' id='text-1927236561'  \/><\/div><div class=\"erf-text form-group field-text-42712659596 erf-element-width-12\"><label for=\"text-42712659596\" class=\"erf-text-label\">Email address of Reporter<span class=\"erf-required\">*<\/span><\/label><input type='text' required='required' maxlength='50' class='form-control' name='text-42712659596' id='text-42712659596'  \/><\/div><div class=\"erf-text form-group field-field-XixHtMx8gkIE4Tc erf-element-width-12\"><label for=\"field-XixHtMx8gkIE4Tc\" class=\"erf-text-label\">Name of lead physician providing carefor liver disease\/post-liver transplant<span class=\"erf-required\">*<\/span><\/label><input type='text' required='required' maxlength='50' class='form-control' name='field-XixHtMx8gkIE4Tc' id='field-XixHtMx8gkIE4Tc'  \/><\/div><div class=\"erf-text form-group field-field-ZM2cTDPL41BaYYy erf-element-width-12\"><label for=\"field-ZM2cTDPL41BaYYy\" class=\"erf-text-label\">Name of center providing care for liverdisease\/post-liver transplant<span class=\"erf-required\">*<\/span><\/label><input type='text' required='required' maxlength='50' class='form-control' name='field-ZM2cTDPL41BaYYy' id='field-ZM2cTDPL41BaYYy'  \/><\/div><div class=\"erf-text form-group field-field-0cfKh8u6U5ktJmj erf-element-width-12\"><label for=\"field-0cfKh8u6U5ktJmj\" class=\"erf-text-label\">Name of hospital where patient received carefor COVID 19 (enter 'NA' if patient not hospitalized)<span class=\"erf-required\">*<\/span><\/label><input type='text' required='required' maxlength='50' class='form-control' name='field-0cfKh8u6U5ktJmj' id='field-0cfKh8u6U5ktJmj'  \/><\/div><div class=\"erf-header erf-element-width-12\"><h1  data-non-input='1' data-ref-label='ref-voL5BYpr' data-ref-id='ref-7cIo0nGX' class='' >Patient Information<\/h1><\/div><div class=\"erf-radio-group form-group field-field-tthrsrohmT5WNxx erf-element-width-7\"><label for=\"field-tthrsrohmT5WNxx\" class=\"erf-radio-group-label\">Is the patient >90 years of age?<span class=\"erf-required\">*<\/span><\/label><div class=\"radio-group\"><div class=\"radio\"><input id=\"field-tthrsrohmT5WNxx-0\" name='field-tthrsrohmT5WNxx' required='required' class='form-control'  type=\"radio\" value=\"Age greater than 90\" \/><label for=\"field-tthrsrohmT5WNxx-0\">Yes<\/label><\/div><div class=\"radio\"><input id=\"field-tthrsrohmT5WNxx-1\" name='field-tthrsrohmT5WNxx' required='required' class='form-control'  type=\"radio\" checked value=\"Age less than 90\" \/><label for=\"field-tthrsrohmT5WNxx-1\">No<\/label><\/div><\/div><\/div><div class=\"erf-separator erf-element-width-12\"><div data-non-input='1' custom-type='spacer' class='spacer' data-ref-label='ref-Li1TcHhq' data-ref-id='ref-pZcHevSt' >Separator<\/div><\/div><div class=\"erf-text form-group field-field-6DMZD0G3CllEP2q erf-element-width-3\"><label for=\"field-6DMZD0G3CllEP2q\" class=\"erf-text-label\">Age<span class=\"erf-required\">*<\/span><\/label><input type='text' class='form-control' name='field-6DMZD0G3CllEP2q' maxlength='2' required='required' id='field-6DMZD0G3CllEP2q'  \/><\/div><div class=\"erf-select form-group field-field-A3JFJkpEENsv1ei erf-element-width-12\"><label for=\"field-A3JFJkpEENsv1ei\" class=\"erf-country-label\">Country of residence<\/label><select class='form-control' name='field-A3JFJkpEENsv1ei' id='field-A3JFJkpEENsv1ei'  ><\/select><\/div><div class=\"erf-radio-group form-group field-field-AU1fviImaP5htyC erf-element-width-5\"><label for=\"field-AU1fviImaP5htyC\" class=\"erf-radio-group-label\">Gender<span class=\"erf-required\">*<\/span><\/label><div class=\"radio-group\"><div class=\"radio\"><input id=\"field-AU1fviImaP5htyC-0\" name='field-AU1fviImaP5htyC' required='required' class='form-control other-option'  type=\"radio\" value=\"Male\" \/><label for=\"field-AU1fviImaP5htyC-0\">Male<\/label><\/div><div class=\"radio\"><input id=\"field-AU1fviImaP5htyC-1\" name='field-AU1fviImaP5htyC' required='required' class='form-control other-option'  type=\"radio\" value=\"Female\" \/><label for=\"field-AU1fviImaP5htyC-1\">Female<\/label><\/div><div class=\"radio-inline\"><input name='field-AU1fviImaP5htyC' required='required' class='form-control other-option'  type=\"radio\" value=\"\" \/><label for=\"field-AU1fviImaP5htyC\">Other<input type=\"text\" id=\"field-AU1fviImaP5htyC-other-value\" class=\"other-val\"><\/label><\/div><\/div><\/div><div class=\"erf-button form-group field-button-18487862174 erf-element-width-12\"><button type='submit'class='btn btn-default'name='button-18487862174'id='button-18487862174'>Send<\/button><\/div>                    <\/div> \n                <\/div>    \n\n                <div class=\"erf-external-form-elements\">\n                    \n                    \n                    \n\n                    \n                                        <div class=\"erf-errors\" style=\"display:none\">\n                        <span class=\"erf-errors-head erf-error-row\">Error occured. Please confirm your data and submit again:<\/span>\n                        <div class=\"erf-errors-body\">\n                                                    <\/div> \n                    <\/div>\n\n                <\/div>\n                <!-- Contains multipage Next,Previous buttons -->\n                <div class=\"erf-form-nav clearfix\"><\/div> \n\n                <!-- Single page form button -->\n                <div class=\"erf-submit-button clearfix\"><\/div>\n\n\n                <input type=\"hidden\" name=\"erform_id\" value=\"1883\" \/>\n                <input type=\"hidden\" name=\"erform_submission_nonce\" value=\"2415cebb65\" \/>\n                <input type=\"hidden\" name=\"action\" value=\"erf_submit_form\" \/>\n\n            <\/form>\n            \n<\/div>\n","protected":false},"excerpt":{"rendered":"Contact us by filling out the form below. Reporter InformationName of Reporter*Email address of Reporter*Name of lead physician providing carefor liver disease\/post-liver transplant*Name of center providing care for liverdisease\/post-liver transplant*Name of hospital where patient received carefor COVID 19 (enter 'NA' if patient","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1885","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"http:\/\/liversummit.com\/index.php\/wp-json\/wp\/v2\/pages\/1885"}],"collection":[{"href":"http:\/\/liversummit.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/liversummit.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/liversummit.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/liversummit.com\/index.php\/wp-json\/wp\/v2\/comments?post=1885"}],"version-history":[{"count":1,"href":"http:\/\/liversummit.com\/index.php\/wp-json\/wp\/v2\/pages\/1885\/revisions"}],"predecessor-version":[{"id":1886,"href":"http:\/\/liversummit.com\/index.php\/wp-json\/wp\/v2\/pages\/1885\/revisions\/1886"}],"wp:attachment":[{"href":"http:\/\/liversummit.com\/index.php\/wp-json\/wp\/v2\/media?parent=1885"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}