{"id":1762,"date":"2022-08-02T03:04:37","date_gmt":"2022-08-02T08:04:37","guid":{"rendered":"https:\/\/trilabhealth.com\/covidtesting\/?page_id=1762"},"modified":"2022-08-12T06:53:59","modified_gmt":"2022-08-12T11:53:59","slug":"provider","status":"publish","type":"page","link":"https:\/\/trilabhealth.com\/covidtesting\/provider\/","title":{"rendered":"Provider"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1762\" class=\"elementor elementor-1762\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5bacb16 bbn elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle tf-sticky-section tf-sticky-no\" data-id=\"5bacb16\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;tf_sticky&quot;:&quot;no&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\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-2df13b7\" data-id=\"2df13b7\" 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-054078e elementor-invisible elementor-widget elementor-widget-heading\" data-id=\"054078e\" data-element_type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeInUp&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.9.1 - 14-12-2022 *\/\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><h3 class=\"elementor-heading-title elementor-size-default\">Provider <\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a3b94b1 elementor-icon-list--layout-inline elementor-list-item-link-full_width elementor-invisible elementor-widget elementor-widget-icon-list\" data-id=\"a3b94b1\" data-element_type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeInUp&quot;}\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<link rel=\"stylesheet\" href=\"https:\/\/trilabhealth.com\/covidtesting\/wp-content\/plugins\/elementor\/assets\/css\/widget-icon-list.min.css\">\t\t<ul class=\"elementor-icon-list-items elementor-inline-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item elementor-inline-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Home<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item elementor-inline-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"\/contact\">\n\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Provider<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\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-ebfb488 elementor-section-boxed elementor-section-height-default elementor-section-height-default tf-sticky-section tf-sticky-no\" data-id=\"ebfb488\" data-element_type=\"section\" data-settings=\"{&quot;tf_sticky&quot;:&quot;no&quot;}\">\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-c90a530\" data-id=\"c90a530\" 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-8417e54 elementor-widget elementor-widget-heading\" data-id=\"8417e54\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">To Access Provider Portal<\/h4>\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-ad0522a\" data-id=\"ad0522a\" 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-dd961f1 elementor-align-left elementor-mobile-align-center elementor-widget elementor-widget-button\" data-id=\"dd961f1\" 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 href=\"https:\/\/reports.trilabhealth.com\/\" class=\"elementor-button-link elementor-button elementor-size-sm\" role=\"button\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t<span class=\"elementor-button-icon elementor-align-icon-left\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-user\"><\/i>\t\t\t<\/span>\n\t\t\t\t\t\t<span class=\"elementor-button-text\">Provider Portal<\/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<div class=\"elementor-element elementor-element-4062866 elementor-hidden-desktop elementor-hidden-tablet elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"4062866\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.9.1 - 14-12-2022 *\/\n.elementor-widget-divider{--divider-border-style:none;--divider-border-width:1px;--divider-color:#2c2c2c;--divider-icon-size:20px;--divider-element-spacing:10px;--divider-pattern-height:24px;--divider-pattern-size:20px;--divider-pattern-url:none;--divider-pattern-repeat:repeat-x}.elementor-widget-divider .elementor-divider{display:flex}.elementor-widget-divider .elementor-divider__text{font-size:15px;line-height:1;max-width:95%}.elementor-widget-divider .elementor-divider__element{margin:0 var(--divider-element-spacing);flex-shrink:0}.elementor-widget-divider .elementor-icon{font-size:var(--divider-icon-size)}.elementor-widget-divider .elementor-divider-separator{display:flex;margin:0;direction:ltr}.elementor-widget-divider--view-line_icon .elementor-divider-separator,.elementor-widget-divider--view-line_text .elementor-divider-separator{align-items:center}.elementor-widget-divider--view-line_icon .elementor-divider-separator:after,.elementor-widget-divider--view-line_icon .elementor-divider-separator:before,.elementor-widget-divider--view-line_text .elementor-divider-separator:after,.elementor-widget-divider--view-line_text .elementor-divider-separator:before{display:block;content:\"\";border-bottom:0;flex-grow:1;border-top:var(--divider-border-width) var(--divider-border-style) var(--divider-color)}.elementor-widget-divider--element-align-left .elementor-divider .elementor-divider-separator>.elementor-divider__svg:first-of-type{flex-grow:0;flex-shrink:100}.elementor-widget-divider--element-align-left .elementor-divider-separator:before{content:none}.elementor-widget-divider--element-align-left .elementor-divider__element{margin-left:0}.elementor-widget-divider--element-align-right .elementor-divider .elementor-divider-separator>.elementor-divider__svg:last-of-type{flex-grow:0;flex-shrink:100}.elementor-widget-divider--element-align-right .elementor-divider-separator:after{content:none}.elementor-widget-divider--element-align-right .elementor-divider__element{margin-right:0}.elementor-widget-divider:not(.elementor-widget-divider--view-line_text):not(.elementor-widget-divider--view-line_icon) .elementor-divider-separator{border-top:var(--divider-border-width) var(--divider-border-style) var(--divider-color)}.elementor-widget-divider--separator-type-pattern{--divider-border-style:none}.elementor-widget-divider--separator-type-pattern.elementor-widget-divider--view-line .elementor-divider-separator,.elementor-widget-divider--separator-type-pattern:not(.elementor-widget-divider--view-line) .elementor-divider-separator:after,.elementor-widget-divider--separator-type-pattern:not(.elementor-widget-divider--view-line) .elementor-divider-separator:before,.elementor-widget-divider--separator-type-pattern:not([class*=elementor-widget-divider--view]) .elementor-divider-separator{width:100%;min-height:var(--divider-pattern-height);-webkit-mask-size:var(--divider-pattern-size) 100%;mask-size:var(--divider-pattern-size) 100%;-webkit-mask-repeat:var(--divider-pattern-repeat);mask-repeat:var(--divider-pattern-repeat);background-color:var(--divider-color);-webkit-mask-image:var(--divider-pattern-url);mask-image:var(--divider-pattern-url)}.elementor-widget-divider--no-spacing{--divider-pattern-size:auto}.elementor-widget-divider--bg-round{--divider-pattern-repeat:round}.rtl .elementor-widget-divider .elementor-divider__text{direction:rtl}.e-con-inner>.elementor-widget-divider,.e-con>.elementor-widget-divider{width:var(--container-widget-width);--flex-grow:var(--container-widget-flex-grow)}<\/style>\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\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\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-6e7e701 elementor-section-boxed elementor-section-height-default elementor-section-height-default tf-sticky-section tf-sticky-no\" data-id=\"6e7e701\" data-element_type=\"section\" data-settings=\"{&quot;tf_sticky&quot;:&quot;no&quot;}\">\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-3df2535\" data-id=\"3df2535\" 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-505a440 elementor-widget elementor-widget-heading\" data-id=\"505a440\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Send Trilab a Message<\/h2>\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-7f77b95 elementor-section-boxed elementor-section-height-default elementor-section-height-default tf-sticky-section tf-sticky-no\" data-id=\"7f77b95\" data-element_type=\"section\" data-settings=\"{&quot;tf_sticky&quot;:&quot;no&quot;}\">\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-622940d\" data-id=\"622940d\" 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-b491315 elementor-widget elementor-widget-metform\" data-id=\"b491315\" data-element_type=\"widget\" data-widget_type=\"metform.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<div id=\"mf-response-props-id-1767\" data-previous-steps-style=\"\" data-editswitchopen=\"\" data-response_type=\"alert\" data-erroricon=\"fas fa-exclamation-triangle\" data-successicon=\"fas fa-check\" data-messageposition=\"top\" class=\"   mf-scroll-top-no\">\n\t\t<div class=\"formpicker_warper formpicker_warper_editable\" data-metform-formpicker-key=\"1767\" >\n\t\t\t\t\n\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\r\n\t\t<div\r\n\t\t\tid=\"metform-wrap-b491315-1767\"\r\n\t\t\tclass=\"mf-form-wrapper\"\r\n\t\t\tdata-form-id=\"1767\"\r\n\t\t\tdata-action=\"https:\/\/trilabhealth.com\/covidtesting\/wp-json\/metform\/v1\/entries\/insert\/1767\"\r\n\t\t\tdata-wp-nonce=\"e7518c9a15\"\r\n\t\t\tdata-form-nonce=\"56d61fc6aa\"\r\n\t\t\tdata-quiz-summery = \"false\"\r\n\t\t\tdata-save-progress = \"false\"\r\n\t\t\tdata-form-type=\"contact_form\"\r\n\t\t\tdata-stop-vertical-effect=\"\"\r\n\t\t\t><\/div>\r\n\r\n\r\n\t\t<!----------------------------- \r\n\t\t\t* controls_data : find the the props passed indie of data attribute\r\n\t\t\t* props.SubmitResponseMarkup : contains the markup of error or success message\r\n\t\t\t* https:\/\/developer.mozilla.org\/en-US\/docs\/Web\/JavaScript\/Reference\/Template_literals\r\n\t\t--------------------------- -->\r\n\r\n\t\t\t\t<script type=\"text\/mf\" class=\"mf-template\">\r\n\t\t\tfunction controls_data (value){\r\n\t\t\t\tlet currentWrapper = \"mf-response-props-id-1767\";\r\n\t\t\t\tlet currentEl = document.getElementById(currentWrapper);\r\n\t\t\t\t\r\n\t\t\t\treturn currentEl ? currentEl.dataset[value] : false\r\n\t\t\t}\r\n\r\n\r\n\t\t\tlet is_edit_mode = '' ? true : false;\r\n\t\t\tlet message_position = controls_data('messageposition') || 'top';\r\n\r\n\t\t\t\r\n\t\t\tlet message_successIcon = controls_data('successicon') || '';\r\n\t\t\tlet message_errorIcon = controls_data('erroricon') || '';\r\n\t\t\tlet message_editSwitch = controls_data('editswitchopen') === 'yes' ? true : false;\r\n\t\t\tlet message_proClass = controls_data('editswitchopen') === 'yes' ? 'mf_pro_activated' : '';\r\n\t\t\t\r\n\t\t\tlet is_dummy_markup = is_edit_mode && message_editSwitch ? true : false;\r\n\r\n\t\t\t\r\n\t\t\treturn html`\r\n\t\t\t\t<form\r\n\t\t\t\t\tclassName=\"metform-form-content\"\r\n\t\t\t\t\tref=${parent.formContainerRef}\r\n\t\t\t\t\tonSubmit=${ validation.handleSubmit( parent.handleFormSubmit ) }\r\n\t\t\t\t\r\n\t\t\t\t\t>\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\t\t${is_dummy_markup ? message_position === 'top' ?  props.ResponseDummyMarkup(message_successIcon, message_proClass) : '' : ''}\r\n\t\t\t\t\t${is_dummy_markup ? ' ' :  message_position === 'top' ? props.SubmitResponseMarkup`${parent}${state}${message_successIcon}${message_errorIcon}${message_proClass}` : ''}\r\n\r\n\t\t\t\t\t<!--------------------------------------------------------\r\n\t\t\t\t\t*** IMPORTANT \/ DANGEROUS ***\r\n\t\t\t\t\t${html``} must be used as in immediate child of \"metform-form-main-wrapper\"\r\n\t\t\t\t\tclass otherwise multistep form will not run at all\r\n\t\t\t\t\t---------------------------------------------------------->\r\n\r\n\t\t\t\t\t<div className=\"metform-form-main-wrapper\" key=${'hide-form-after-submit'} ref=${parent.formRef}>\r\n\t\t\t\t\t${html`\r\n\t\t\t\t\t\t\t\t<div data-elementor-type=\"wp-post\" key=\"2\" data-elementor-id=\"1767\" className=\"elementor elementor-1767\">\n\t\t\t\t\t\t\t\t\t<section className=\"elementor-section elementor-top-section elementor-element elementor-element-112caa99 elementor-section-boxed elementor-section-height-default elementor-section-height-default tf-sticky-section tf-sticky-no\" data-id=\"112caa99\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;tf_sticky&quot;:&quot;no&quot;}\">\n\t\t\t\t\t\t<div className=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div className=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7129e22e\" data-id=\"7129e22e\" data-element_type=\"column\">\n\t\t\t<div className=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<section className=\"elementor-section elementor-inner-section elementor-element elementor-element-123ce7e1 elementor-section-boxed elementor-section-height-default elementor-section-height-default tf-sticky-section tf-sticky-no\" data-id=\"123ce7e1\" data-element_type=\"section\" data-settings=\"{&quot;tf_sticky&quot;:&quot;no&quot;}\">\n\t\t\t\t\t\t<div className=\"elementor-container elementor-column-gap-extended\">\n\t\t\t\t\t<div className=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-2f06789b\" data-id=\"2f06789b\" data-element_type=\"column\">\n\t\t\t<div className=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div className=\"elementor-element elementor-element-5c2cd79a elementor-widget elementor-widget-mf-text\" data-id=\"5c2cd79a\" data-element_type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-text_867784&quot;}\" data-widget_type=\"mf-text.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-text-5c2cd79a\">\r\n\t\t\t\t\t${ parent.decodeEntities(`What is the name of your organization, practice, or business?`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\r\n\t\t\t\t<\/label>\r\n\t\t\t\r\n\t\t\t<input\r\n\t\t\t\ttype=\"text\"\r\n\t\t\t\tclassName=\"mf-input \"\r\n\t\t\t\tid=\"mf-input-text-5c2cd79a\"\r\n\t\t\t\tname=\"mf-text_867784\"\r\n\t\t\t\tplaceholder=\"${ parent.decodeEntities(``) } \"\r\n\t\t\t\t\t\t\t\t\tonInput=${parent.handleChange}\r\n\t\t\t\t\taria-invalid=${validation.errors['mf-text_867784'] ? 'true' : 'false'}\r\n\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true,\"expression\":\"null\"}, el)\r\n\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\/>\r\n\r\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\r\n\t\t\t\t\terrors=${validation.errors}\r\n\t\t\t\t\tname=\"mf-text_867784\"\r\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\t\t\/>\r\n\t\t\t\r\n\t\t\t\t\t<\/div>\r\n\r\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 className=\"elementor-section elementor-inner-section elementor-element elementor-element-29314d7c elementor-section-boxed elementor-section-height-default elementor-section-height-default tf-sticky-section tf-sticky-no\" data-id=\"29314d7c\" data-element_type=\"section\" data-settings=\"{&quot;tf_sticky&quot;:&quot;no&quot;}\">\n\t\t\t\t\t\t<div className=\"elementor-container elementor-column-gap-extended\">\n\t\t\t\t\t<div className=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-7d998eda\" data-id=\"7d998eda\" data-element_type=\"column\">\n\t\t\t<div className=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div className=\"elementor-element elementor-element-5e94dc77 elementor-widget elementor-widget-mf-select\" data-id=\"5e94dc77\" data-element_type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-select_606957&quot;,&quot;mf_input_list&quot;:[{&quot;mf_input_option_text&quot;:&quot;Ambulatory Care\\\/Clinic&quot;,&quot;mf_input_option_value&quot;:&quot;Ambulatory Care\\\/Clinic&quot;,&quot;_id&quot;:&quot;71231c6&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Health System&quot;,&quot;mf_input_option_value&quot;:&quot;Health System&quot;,&quot;_id&quot;:&quot;aa139d3&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Hospital\\\/Acute Care&quot;,&quot;mf_input_option_value&quot;:&quot;Hospital\\\/Acute Care&quot;,&quot;_id&quot;:&quot;2866568&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Primary Care&quot;,&quot;mf_input_option_value&quot;:&quot;Primary Care&quot;,&quot;_id&quot;:&quot;7cc741f&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;_id&quot;:&quot;4be4a9b&quot;,&quot;mf_input_option_text&quot;:&quot;Specialty Care&quot;,&quot;mf_input_option_value&quot;:&quot;Specialty Care&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;_id&quot;:&quot;7e697b7&quot;,&quot;mf_input_option_text&quot;:&quot;Accountable Care Organization (ACO)&quot;,&quot;mf_input_option_value&quot;:&quot;Accountable Care Organization (ACO)&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;_id&quot;:&quot;e29725a&quot;,&quot;mf_input_option_text&quot;:&quot;Federally Qualified Health Center (FQHC)&quot;,&quot;mf_input_option_value&quot;:&quot;Federally Qualified Health Center (FQHC)&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;}]}\" data-widget_type=\"mf-select.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\n\t\t\n\t\t<div className=\"mf-input-wrapper\">\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-select-5e94dc77\">\n\t\t\t\t\t${ parent.decodeEntities(`Please select the option that best fits your organization:`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\n\t\t\t\t<\/label>\n            \n            <${props.Select}\n                className=${\"mf-input mf-input-select  \" + ( validation.errors['mf-select_606957'] ? 'mf-invalid' : '' )}\n                classNamePrefix=\"mf_select\"\n                name=\"mf-select_606957\"\n                placeholder=\"${ parent.decodeEntities(`Please Select`) } \"\n                isSearchable=${false}\n                options=${[{\"label\":\"Ambulatory Care\\\/Clinic\",\"value\":\"Ambulatory Care\\\/Clinic\",\"isDisabled\":false},{\"label\":\"Health System\",\"value\":\"Health System\",\"isDisabled\":false},{\"label\":\"Hospital\\\/Acute Care\",\"value\":\"Hospital\\\/Acute Care\",\"isDisabled\":false},{\"label\":\"Primary Care\",\"value\":\"Primary Care\",\"isDisabled\":false},{\"label\":\"Specialty Care\",\"value\":\"Specialty Care\",\"isDisabled\":false},{\"label\":\"Accountable Care Organization (ACO)\",\"value\":\"Accountable Care Organization (ACO)\",\"isDisabled\":false},{\"label\":\"Federally Qualified Health Center (FQHC)\",\"value\":\"Federally Qualified Health Center (FQHC)\",\"isDisabled\":false}]}\n                value=${parent.getValue(\"mf-select_606957\") ? [{\"label\":\"Ambulatory Care\\\/Clinic\",\"value\":\"Ambulatory Care\\\/Clinic\",\"isDisabled\":false},{\"label\":\"Health System\",\"value\":\"Health System\",\"isDisabled\":false},{\"label\":\"Hospital\\\/Acute Care\",\"value\":\"Hospital\\\/Acute Care\",\"isDisabled\":false},{\"label\":\"Primary Care\",\"value\":\"Primary Care\",\"isDisabled\":false},{\"label\":\"Specialty Care\",\"value\":\"Specialty Care\",\"isDisabled\":false},{\"label\":\"Accountable Care Organization (ACO)\",\"value\":\"Accountable Care Organization (ACO)\",\"isDisabled\":false},{\"label\":\"Federally Qualified Health Center (FQHC)\",\"value\":\"Federally Qualified Health Center (FQHC)\",\"isDisabled\":false}].filter(item => item.value === parent.getValue(\"mf-select_606957\"))[0] : []}\n                onChange=${(e)=> parent.handleSelect(e, \"mf-select_606957\")}\n                ref=${() => {\n\t\t\t\t                    register({ name: \"mf-select_606957\" }, parent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true}));\n                    if ( parent.getValue(\"mf-select_606957\") === '' && false ) {\n\t\t\t\t    parent.setValue( 'mf-select_606957', '', true );\n                        parent.handleChange({\n                            target: {\n                                name: 'mf-select_606957',\n                                value: ''\n                            }\n                        });\n                    }\n                }}\n                \/>\n\n            \t\t\t\t<${validation.ErrorMessage}\n\t\t\t\t\terrors=${validation.errors}\n\t\t\t\t\tname=\"mf-select_606957\"\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\n\t\t\t\t\t\/>\n\t\t\t\n            \t\t<\/div>\n\n\t\t\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div className=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-5c7b82c4\" data-id=\"5c7b82c4\" data-element_type=\"column\">\n\t\t\t<div className=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div className=\"elementor-element elementor-element-7e2fb1af elementor-widget elementor-widget-mf-select\" data-id=\"7e2fb1af\" data-element_type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-select_531975&quot;}\" data-widget_type=\"mf-select.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\n\t\t\n\t\t<div className=\"mf-input-wrapper\">\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-select-7e2fb1af\">\n\t\t\t\t\t${ parent.decodeEntities(`What is your organization&#039;s Primary Specialty?`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\n\t\t\t\t<\/label>\n            \n            <${props.Select}\n                className=${\"mf-input mf-input-select  \" + ( validation.errors['mf-select_531975'] ? 'mf-invalid' : '' )}\n                classNamePrefix=\"mf_select\"\n                name=\"mf-select_531975\"\n                placeholder=\"${ parent.decodeEntities(`Please Select`) } \"\n                isSearchable=${false}\n                options=${[{\"label\":\"Allergy & Immunology\",\"value\":\"Allergy & Immunology\",\"isDisabled\":false},{\"label\":\"Anesthesiology\",\"value\":\"Anesthesiology\",\"isDisabled\":false},{\"label\":\"Cardiology\",\"value\":\"Cardiology\",\"isDisabled\":false},{\"label\":\"Chiropractor\",\"value\":\"Chiropractor\",\"isDisabled\":false},{\"label\":\"Dentistry\",\"value\":\"Dentistry\",\"isDisabled\":false},{\"label\":\"Dermatology\",\"value\":\"Dermatology\",\"isDisabled\":false},{\"label\":\"Emergency Medicine\",\"value\":\"Emergency Medicine\",\"isDisabled\":false},{\"label\":\"Endocrinology\",\"value\":\"Endocrinology\",\"isDisabled\":false},{\"label\":\"Eye Ear Nose & Throat\",\"value\":\"Eye Ear Nose & Throat\",\"isDisabled\":false},{\"label\":\"Family Practice\",\"value\":\"Family Practice\",\"isDisabled\":false},{\"label\":\"Gastroenterology\",\"value\":\"Gastroenterology\",\"isDisabled\":false},{\"label\":\"General Practice\",\"value\":\"General Practice\",\"isDisabled\":false},{\"label\":\"Genetics\",\"value\":\"Genetics\",\"isDisabled\":false},{\"label\":\"Geriatrics\",\"value\":\"Geriatrics\",\"isDisabled\":false},{\"label\":\"Hematology\",\"value\":\"Hematology\",\"isDisabled\":false},{\"label\":\"Hospice\",\"value\":\"Hospice\",\"isDisabled\":false},{\"label\":\"Infectious Diseases\",\"value\":\"Infectious Diseases\",\"isDisabled\":false},{\"label\":\"Internal Medicine\",\"value\":\"Internal Medicine\",\"isDisabled\":false},{\"label\":\"Nephrology\",\"value\":\"Nephrology\",\"isDisabled\":false},{\"label\":\"Neurology\",\"value\":\"Neurology\",\"isDisabled\":false},{\"label\":\"Obstetrics & Gynecology\",\"value\":\"Obstetrics & Gynecology\",\"isDisabled\":false},{\"label\":\"Oncology\",\"value\":\"Oncology\",\"isDisabled\":false},{\"label\":\"Ophthalmology\",\"value\":\"Ophthalmology\",\"isDisabled\":false},{\"label\":\"Osteopathy\",\"value\":\"Osteopathy\",\"isDisabled\":false},{\"label\":\"Pathology\",\"value\":\"Pathology\",\"isDisabled\":false},{\"label\":\"Pediatrics\",\"value\":\"Pediatrics\",\"isDisabled\":false},{\"label\":\"Physical Medicine & Rehabilitation\",\"value\":\"Physical Medicine & Rehabilitation\",\"isDisabled\":false},{\"label\":\"Podiatry\",\"value\":\"Podiatry\",\"isDisabled\":false},{\"label\":\"Psychiatry\",\"value\":\"Psychiatry\",\"isDisabled\":false},{\"label\":\"Pulmonary\",\"value\":\"Pulmonary\",\"isDisabled\":false},{\"label\":\"Radiology\",\"value\":\"Radiology\",\"isDisabled\":false},{\"label\":\"Rheumatology\",\"value\":\"Rheumatology\",\"isDisabled\":false},{\"label\":\"Surgery\",\"value\":\"Surgery\",\"isDisabled\":false},{\"label\":\"Urology\",\"value\":\"Urology\",\"isDisabled\":false}]}\n                value=${parent.getValue(\"mf-select_531975\") ? [{\"label\":\"Allergy & Immunology\",\"value\":\"Allergy & Immunology\",\"isDisabled\":false},{\"label\":\"Anesthesiology\",\"value\":\"Anesthesiology\",\"isDisabled\":false},{\"label\":\"Cardiology\",\"value\":\"Cardiology\",\"isDisabled\":false},{\"label\":\"Chiropractor\",\"value\":\"Chiropractor\",\"isDisabled\":false},{\"label\":\"Dentistry\",\"value\":\"Dentistry\",\"isDisabled\":false},{\"label\":\"Dermatology\",\"value\":\"Dermatology\",\"isDisabled\":false},{\"label\":\"Emergency Medicine\",\"value\":\"Emergency Medicine\",\"isDisabled\":false},{\"label\":\"Endocrinology\",\"value\":\"Endocrinology\",\"isDisabled\":false},{\"label\":\"Eye Ear Nose & Throat\",\"value\":\"Eye Ear Nose & Throat\",\"isDisabled\":false},{\"label\":\"Family Practice\",\"value\":\"Family Practice\",\"isDisabled\":false},{\"label\":\"Gastroenterology\",\"value\":\"Gastroenterology\",\"isDisabled\":false},{\"label\":\"General Practice\",\"value\":\"General Practice\",\"isDisabled\":false},{\"label\":\"Genetics\",\"value\":\"Genetics\",\"isDisabled\":false},{\"label\":\"Geriatrics\",\"value\":\"Geriatrics\",\"isDisabled\":false},{\"label\":\"Hematology\",\"value\":\"Hematology\",\"isDisabled\":false},{\"label\":\"Hospice\",\"value\":\"Hospice\",\"isDisabled\":false},{\"label\":\"Infectious Diseases\",\"value\":\"Infectious Diseases\",\"isDisabled\":false},{\"label\":\"Internal Medicine\",\"value\":\"Internal Medicine\",\"isDisabled\":false},{\"label\":\"Nephrology\",\"value\":\"Nephrology\",\"isDisabled\":false},{\"label\":\"Neurology\",\"value\":\"Neurology\",\"isDisabled\":false},{\"label\":\"Obstetrics & Gynecology\",\"value\":\"Obstetrics & Gynecology\",\"isDisabled\":false},{\"label\":\"Oncology\",\"value\":\"Oncology\",\"isDisabled\":false},{\"label\":\"Ophthalmology\",\"value\":\"Ophthalmology\",\"isDisabled\":false},{\"label\":\"Osteopathy\",\"value\":\"Osteopathy\",\"isDisabled\":false},{\"label\":\"Pathology\",\"value\":\"Pathology\",\"isDisabled\":false},{\"label\":\"Pediatrics\",\"value\":\"Pediatrics\",\"isDisabled\":false},{\"label\":\"Physical Medicine & Rehabilitation\",\"value\":\"Physical Medicine & Rehabilitation\",\"isDisabled\":false},{\"label\":\"Podiatry\",\"value\":\"Podiatry\",\"isDisabled\":false},{\"label\":\"Psychiatry\",\"value\":\"Psychiatry\",\"isDisabled\":false},{\"label\":\"Pulmonary\",\"value\":\"Pulmonary\",\"isDisabled\":false},{\"label\":\"Radiology\",\"value\":\"Radiology\",\"isDisabled\":false},{\"label\":\"Rheumatology\",\"value\":\"Rheumatology\",\"isDisabled\":false},{\"label\":\"Surgery\",\"value\":\"Surgery\",\"isDisabled\":false},{\"label\":\"Urology\",\"value\":\"Urology\",\"isDisabled\":false}].filter(item => item.value === parent.getValue(\"mf-select_531975\"))[0] : []}\n                onChange=${(e)=> parent.handleSelect(e, \"mf-select_531975\")}\n                ref=${() => {\n\t\t\t\t                    register({ name: \"mf-select_531975\" }, parent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true}));\n                    if ( parent.getValue(\"mf-select_531975\") === '' && false ) {\n\t\t\t\t    parent.setValue( 'mf-select_531975', '', true );\n                        parent.handleChange({\n                            target: {\n                                name: 'mf-select_531975',\n                                value: ''\n                            }\n                        });\n                    }\n                }}\n                \/>\n\n            \t\t\t\t<${validation.ErrorMessage}\n\t\t\t\t\terrors=${validation.errors}\n\t\t\t\t\tname=\"mf-select_531975\"\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\n\t\t\t\t\t\/>\n\t\t\t\n            \t\t<\/div>\n\n\t\t\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section className=\"elementor-section elementor-inner-section elementor-element elementor-element-3782c90b elementor-section-boxed elementor-section-height-default elementor-section-height-default tf-sticky-section tf-sticky-no\" data-id=\"3782c90b\" data-element_type=\"section\" data-settings=\"{&quot;tf_sticky&quot;:&quot;no&quot;}\">\n\t\t\t\t\t\t<div className=\"elementor-container elementor-column-gap-extended\">\n\t\t\t\t\t<div className=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-4f0a6032\" data-id=\"4f0a6032\" data-element_type=\"column\">\n\t\t\t<div className=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div className=\"elementor-element elementor-element-a9f0d56 elementor-widget elementor-widget-mf-text\" data-id=\"a9f0d56\" data-element_type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-text_342641&quot;}\" data-widget_type=\"mf-text.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-text-a9f0d56\">\r\n\t\t\t\t\t${ parent.decodeEntities(`First Name`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\r\n\t\t\t\t<\/label>\r\n\t\t\t\r\n\t\t\t<input\r\n\t\t\t\ttype=\"text\"\r\n\t\t\t\tclassName=\"mf-input \"\r\n\t\t\t\tid=\"mf-input-text-a9f0d56\"\r\n\t\t\t\tname=\"mf-text_342641\"\r\n\t\t\t\tplaceholder=\"${ parent.decodeEntities(``) } \"\r\n\t\t\t\t\t\t\t\t\tonInput=${parent.handleChange}\r\n\t\t\t\t\taria-invalid=${validation.errors['mf-text_342641'] ? 'true' : 'false'}\r\n\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true,\"expression\":\"null\"}, el)\r\n\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\/>\r\n\r\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\r\n\t\t\t\t\terrors=${validation.errors}\r\n\t\t\t\t\tname=\"mf-text_342641\"\r\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\t\t\/>\r\n\t\t\t\r\n\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div className=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-147c0c1\" data-id=\"147c0c1\" data-element_type=\"column\">\n\t\t\t<div className=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div className=\"elementor-element elementor-element-14de2c1d elementor-widget elementor-widget-mf-text\" data-id=\"14de2c1d\" data-element_type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-text_907907&quot;}\" data-widget_type=\"mf-text.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-text-14de2c1d\">\r\n\t\t\t\t\t${ parent.decodeEntities(`Last Name`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\r\n\t\t\t\t<\/label>\r\n\t\t\t\r\n\t\t\t<input\r\n\t\t\t\ttype=\"text\"\r\n\t\t\t\tclassName=\"mf-input \"\r\n\t\t\t\tid=\"mf-input-text-14de2c1d\"\r\n\t\t\t\tname=\"mf-text_907907\"\r\n\t\t\t\tplaceholder=\"${ parent.decodeEntities(``) } \"\r\n\t\t\t\t\t\t\t\t\tonInput=${parent.handleChange}\r\n\t\t\t\t\taria-invalid=${validation.errors['mf-text_907907'] ? 'true' : 'false'}\r\n\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true,\"expression\":\"null\"}, el)\r\n\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\/>\r\n\r\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\r\n\t\t\t\t\terrors=${validation.errors}\r\n\t\t\t\t\tname=\"mf-text_907907\"\r\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\t\t\/>\r\n\t\t\t\r\n\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section className=\"elementor-section elementor-inner-section elementor-element elementor-element-4236fdf9 elementor-section-boxed elementor-section-height-default elementor-section-height-default tf-sticky-section tf-sticky-no\" data-id=\"4236fdf9\" data-element_type=\"section\" data-settings=\"{&quot;tf_sticky&quot;:&quot;no&quot;}\">\n\t\t\t\t\t\t<div className=\"elementor-container elementor-column-gap-extended\">\n\t\t\t\t\t<div className=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-6502ae29\" data-id=\"6502ae29\" data-element_type=\"column\">\n\t\t\t<div className=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div className=\"elementor-element elementor-element-17b3efa elementor-widget elementor-widget-mf-email\" data-id=\"17b3efa\" data-element_type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-email_673419&quot;}\" data-widget_type=\"mf-email.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-email-17b3efa\">\r\n\t\t\t\t\t${ parent.decodeEntities(`Please provide us your professional email address: `) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\r\n\t\t\t\t<\/label>\r\n\t\t\t\r\n\t\t\t<input \r\n\t\t\t\ttype=\"email\" \r\n\t\t\t\t \r\n\t\t\t\tdefaultValue=\"\" \r\n\t\t\t\tclassName=\"mf-input \" \r\n\t\t\t\tid=\"mf-input-email-17b3efa\" \r\n\t\t\t\tname=\"mf-email_673419\" \r\n\t\t\t\tplaceholder=\"${ parent.decodeEntities(``) } \" \r\n\t\t\t\t \r\n\t\t\t\tonInput=${parent.handleChange} aria-invalid=${validation.errors['mf-email_673419'] ? 'true' : 'false' } \r\n\t\t\t\tref=${el=> parent.activateValidation({\"message\":\"This field is required.\",\"emailMessage\":\"Please enter a valid Email address\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true,\"expression\":\"null\"}, el)}\r\n\t\t\t\t\t\t\t\/>\r\n\r\n\t\t\t\t\t\t<${validation.ErrorMessage} \r\n\t\t\t\terrors=${validation.errors} \r\n\t\t\t\tname=\"mf-email_673419\" \r\n\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\/>\r\n\t\t\t\r\n\t\t\t\t\t<\/div>\r\n\r\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div className=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-ab33bba\" data-id=\"ab33bba\" data-element_type=\"column\">\n\t\t\t<div className=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div className=\"elementor-element elementor-element-5136b283 elementor-widget elementor-widget-mf-text\" data-id=\"5136b283\" data-element_type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-text_324736&quot;}\" data-widget_type=\"mf-text.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-text-5136b283\">\r\n\t\t\t\t\t${ parent.decodeEntities(`Please provide your title\/role within your organization:`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\r\n\t\t\t\t<\/label>\r\n\t\t\t\r\n\t\t\t<input\r\n\t\t\t\ttype=\"text\"\r\n\t\t\t\tclassName=\"mf-input \"\r\n\t\t\t\tid=\"mf-input-text-5136b283\"\r\n\t\t\t\tname=\"mf-text_324736\"\r\n\t\t\t\tplaceholder=\"${ parent.decodeEntities(``) } \"\r\n\t\t\t\t\t\t\t\t\tonInput=${parent.handleChange}\r\n\t\t\t\t\taria-invalid=${validation.errors['mf-text_324736'] ? 'true' : 'false'}\r\n\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true,\"expression\":\"null\"}, el)\r\n\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\/>\r\n\r\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\r\n\t\t\t\t\terrors=${validation.errors}\r\n\t\t\t\t\tname=\"mf-text_324736\"\r\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\t\t\/>\r\n\t\t\t\r\n\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section className=\"elementor-section elementor-inner-section elementor-element elementor-element-5d124258 elementor-section-boxed elementor-section-height-default elementor-section-height-default tf-sticky-section tf-sticky-no\" data-id=\"5d124258\" data-element_type=\"section\" data-settings=\"{&quot;tf_sticky&quot;:&quot;no&quot;}\">\n\t\t\t\t\t\t<div className=\"elementor-container elementor-column-gap-extended\">\n\t\t\t\t\t<div className=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-605c8104\" data-id=\"605c8104\" data-element_type=\"column\">\n\t\t\t<div className=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div className=\"elementor-element elementor-element-6c924636 elementor-widget elementor-widget-mf-select\" data-id=\"6c924636\" data-element_type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-select_827594&quot;,&quot;mf_input_list&quot;:[{&quot;mf_input_option_text&quot;:&quot;United States&quot;,&quot;mf_input_option_value&quot;:&quot;United States&quot;,&quot;_id&quot;:&quot;8d2af14&quot;,&quot;mf_input_option_selected&quot;:&quot;selected&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;}]}\" data-widget_type=\"mf-select.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\n\t\t\n\t\t<div className=\"mf-input-wrapper\">\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-select-6c924636\">\n\t\t\t\t\t${ parent.decodeEntities(`Please select your country: `) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\n\t\t\t\t<\/label>\n            \n            <${props.Select}\n                className=${\"mf-input mf-input-select  \" + ( validation.errors['mf-select_827594'] ? 'mf-invalid' : '' )}\n                classNamePrefix=\"mf_select\"\n                name=\"mf-select_827594\"\n                placeholder=\"${ parent.decodeEntities(`Please Select`) } \"\n                isSearchable=${false}\n                options=${[{\"label\":\"United States\",\"value\":\"United States\",\"isDisabled\":false}]}\n                value=${parent.getValue(\"mf-select_827594\") ? [{\"label\":\"United States\",\"value\":\"United States\",\"isDisabled\":false}].filter(item => item.value === parent.getValue(\"mf-select_827594\"))[0] : {\"label\":\"United States\",\"value\":\"United States\",\"isDisabled\":false}}\n                onChange=${(e)=> parent.handleSelect(e, \"mf-select_827594\")}\n                ref=${() => {\n\t\t\t\t                    register({ name: \"mf-select_827594\" }, parent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true}));\n                    if ( parent.getValue(\"mf-select_827594\") === '' && true ) {\n\t\t\t\t    parent.setValue( 'mf-select_827594', 'United States', true );\n                        parent.handleChange({\n                            target: {\n                                name: 'mf-select_827594',\n                                value: 'United States'\n                            }\n                        });\n                    }\n                }}\n                \/>\n\n            \t\t\t\t<${validation.ErrorMessage}\n\t\t\t\t\terrors=${validation.errors}\n\t\t\t\t\tname=\"mf-select_827594\"\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\n\t\t\t\t\t\/>\n\t\t\t\n            \t\t<\/div>\n\n\t\t\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div className=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-6652e432\" data-id=\"6652e432\" data-element_type=\"column\">\n\t\t\t<div className=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div className=\"elementor-element elementor-element-6219a788 elementor-widget elementor-widget-mf-select\" data-id=\"6219a788\" data-element_type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-select_874478&quot;}\" data-widget_type=\"mf-select.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\n\t\t\n\t\t<div className=\"mf-input-wrapper\">\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-select-6219a788\">\n\t\t\t\t\t${ parent.decodeEntities(`State or Province`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\n\t\t\t\t<\/label>\n            \n            <${props.Select}\n                className=${\"mf-input mf-input-select  \" + ( validation.errors['mf-select_874478'] ? 'mf-invalid' : '' )}\n                classNamePrefix=\"mf_select\"\n                name=\"mf-select_874478\"\n                placeholder=\"${ parent.decodeEntities(`Please Select`) } \"\n                isSearchable=${false}\n                options=${[{\"label\":\"Alaska\",\"value\":\"Alaska\",\"isDisabled\":false},{\"label\":\"Alabama\",\"value\":\"Alabama\",\"isDisabled\":false},{\"label\":\"Arkansas\",\"value\":\"Arkansas\",\"isDisabled\":false},{\"label\":\"American Samoa\",\"value\":\"American Samoa\",\"isDisabled\":false},{\"label\":\"Arizona\",\"value\":\"Arizona\",\"isDisabled\":false},{\"label\":\"California\",\"value\":\"California\",\"isDisabled\":false},{\"label\":\"Colorado\",\"value\":\"Colorado\",\"isDisabled\":false},{\"label\":\"Connecticut\",\"value\":\"Connecticut\",\"isDisabled\":false},{\"label\":\"D.C.\",\"value\":\"D.C.\",\"isDisabled\":false},{\"label\":\"Delaware\",\"value\":\"Delaware\",\"isDisabled\":false},{\"label\":\"Florida\",\"value\":\"Florida\",\"isDisabled\":false},{\"label\":\"Micronesia\",\"value\":\"Micronesia\",\"isDisabled\":false},{\"label\":\"Georgia\",\"value\":\"Georgia\",\"isDisabled\":false},{\"label\":\"Guam\",\"value\":\"Guam\",\"isDisabled\":false},{\"label\":\"Hawaii\",\"value\":\"Hawaii\",\"isDisabled\":false},{\"label\":\"Iowa\",\"value\":\"Iowa\",\"isDisabled\":false},{\"label\":\"Idaho\",\"value\":\"Idaho\",\"isDisabled\":false},{\"label\":\"Illinois\",\"value\":\"Illinois\",\"isDisabled\":false},{\"label\":\"Indiana\",\"value\":\"Indiana\",\"isDisabled\":false},{\"label\":\"Kansas\",\"value\":\"Kansas\",\"isDisabled\":false},{\"label\":\"Kentucky\",\"value\":\"Kentucky\",\"isDisabled\":false},{\"label\":\"Louisiana\",\"value\":\"Louisiana\",\"isDisabled\":false},{\"label\":\"Massachusetts\",\"value\":\"Massachusetts\",\"isDisabled\":false},{\"label\":\"Maryland\",\"value\":\"Maryland\",\"isDisabled\":false},{\"label\":\"Maine\",\"value\":\"Maine\",\"isDisabled\":false},{\"label\":\"Marshall Islands\",\"value\":\"Marshall Islands\",\"isDisabled\":false},{\"label\":\"Michigan\",\"value\":\"Michigan\",\"isDisabled\":false},{\"label\":\"Minnesota\",\"value\":\"Minnesota\",\"isDisabled\":false},{\"label\":\"Missouri\",\"value\":\"Missouri\",\"isDisabled\":false},{\"label\":\"Marianas\",\"value\":\"Marianas\",\"isDisabled\":false},{\"label\":\"Mississippi\",\"value\":\"Mississippi\",\"isDisabled\":false},{\"label\":\"Montana\",\"value\":\"Montana\",\"isDisabled\":false},{\"label\":\"North Carolina\",\"value\":\"North Carolina\",\"isDisabled\":false},{\"label\":\"North Dakota\",\"value\":\"North Dakota\",\"isDisabled\":false},{\"label\":\"Nebraska\",\"value\":\"Nebraska\",\"isDisabled\":false},{\"label\":\"New Hampshire\",\"value\":\"New Hampshire\",\"isDisabled\":false},{\"label\":\"New Jersey\",\"value\":\"New Jersey\",\"isDisabled\":false},{\"label\":\"New Mexico\",\"value\":\"New Mexico\",\"isDisabled\":false},{\"label\":\"Nevada\",\"value\":\"Nevada\",\"isDisabled\":false},{\"label\":\"New York\",\"value\":\"New York\",\"isDisabled\":false},{\"label\":\"Ohio\",\"value\":\"Ohio\",\"isDisabled\":false},{\"label\":\"Oklahoma\",\"value\":\"Oklahoma\",\"isDisabled\":false},{\"label\":\"Oregon\",\"value\":\"Oregon\",\"isDisabled\":false},{\"label\":\"Pennsylvania\",\"value\":\"Pennsylvania\",\"isDisabled\":false},{\"label\":\"Puerto Rico\",\"value\":\"Puerto Rico\",\"isDisabled\":false},{\"label\":\"Palau\",\"value\":\"Palau\",\"isDisabled\":false},{\"label\":\"Rhode Island\",\"value\":\"Rhode Island\",\"isDisabled\":false},{\"label\":\"South Carolina\",\"value\":\"South Carolina\",\"isDisabled\":false},{\"label\":\"South Dakota\",\"value\":\"South Dakota\",\"isDisabled\":false},{\"label\":\"Tennessee\",\"value\":\"Tennessee\",\"isDisabled\":false},{\"label\":\"Texas\",\"value\":\"Texas\",\"isDisabled\":false},{\"label\":\"Utah\",\"value\":\"Utah\",\"isDisabled\":false},{\"label\":\"Virginia\",\"value\":\"Virginia\",\"isDisabled\":false},{\"label\":\"Virgin Islands\",\"value\":\"Virgin Islands\",\"isDisabled\":false},{\"label\":\"Vermont\",\"value\":\"Vermont\",\"isDisabled\":false},{\"label\":\"Washington\",\"value\":\"Washington\",\"isDisabled\":false},{\"label\":\"Wisconsin\",\"value\":\"Wisconsin\",\"isDisabled\":false},{\"label\":\"West Virginia\",\"value\":\"West Virginia\",\"isDisabled\":false},{\"label\":\"Wyoming\",\"value\":\"Wyoming\",\"isDisabled\":false},{\"label\":\"Armed Forces Americas\",\"value\":\"Armed Forces Americas\",\"isDisabled\":false},{\"label\":\"Armed Forces Europe\",\"value\":\"Armed Forces Europe\",\"isDisabled\":false},{\"label\":\"Armed Forces Pacific\",\"value\":\"Armed Forces Pacific\",\"isDisabled\":false},{\"label\":\"Alberta\",\"value\":\"Alberta\",\"isDisabled\":false},{\"label\":\"Manitoba\",\"value\":\"Manitoba\",\"isDisabled\":false},{\"label\":\"British Columbia\",\"value\":\"British Columbia\",\"isDisabled\":false},{\"label\":\"New Brunswick\",\"value\":\"New Brunswick\",\"isDisabled\":false},{\"label\":\"Newfoundland and Labrador\",\"value\":\"Newfoundland and Labrador\",\"isDisabled\":false},{\"label\":\"Nova Scotia\",\"value\":\"Nova Scotia\",\"isDisabled\":false},{\"label\":\"Northwest Territories\",\"value\":\"Northwest Territories\",\"isDisabled\":false},{\"label\":\"Nunavut\",\"value\":\"Nunavut\",\"isDisabled\":false},{\"label\":\"Ontario\",\"value\":\"Ontario\",\"isDisabled\":false},{\"label\":\"Prince Edward Island\",\"value\":\"Prince Edward Island\",\"isDisabled\":false},{\"label\":\"Quebec\",\"value\":\"Quebec\",\"isDisabled\":false},{\"label\":\"Saskatchewan\",\"value\":\"Saskatchewan\",\"isDisabled\":false},{\"label\":\"Yukon Territory\",\"value\":\"Yukon Territory\",\"isDisabled\":false},{\"label\":\"Outside North America\",\"value\":\"Outside North America\",\"isDisabled\":false}]}\n                value=${parent.getValue(\"mf-select_874478\") ? [{\"label\":\"Alaska\",\"value\":\"Alaska\",\"isDisabled\":false},{\"label\":\"Alabama\",\"value\":\"Alabama\",\"isDisabled\":false},{\"label\":\"Arkansas\",\"value\":\"Arkansas\",\"isDisabled\":false},{\"label\":\"American Samoa\",\"value\":\"American Samoa\",\"isDisabled\":false},{\"label\":\"Arizona\",\"value\":\"Arizona\",\"isDisabled\":false},{\"label\":\"California\",\"value\":\"California\",\"isDisabled\":false},{\"label\":\"Colorado\",\"value\":\"Colorado\",\"isDisabled\":false},{\"label\":\"Connecticut\",\"value\":\"Connecticut\",\"isDisabled\":false},{\"label\":\"D.C.\",\"value\":\"D.C.\",\"isDisabled\":false},{\"label\":\"Delaware\",\"value\":\"Delaware\",\"isDisabled\":false},{\"label\":\"Florida\",\"value\":\"Florida\",\"isDisabled\":false},{\"label\":\"Micronesia\",\"value\":\"Micronesia\",\"isDisabled\":false},{\"label\":\"Georgia\",\"value\":\"Georgia\",\"isDisabled\":false},{\"label\":\"Guam\",\"value\":\"Guam\",\"isDisabled\":false},{\"label\":\"Hawaii\",\"value\":\"Hawaii\",\"isDisabled\":false},{\"label\":\"Iowa\",\"value\":\"Iowa\",\"isDisabled\":false},{\"label\":\"Idaho\",\"value\":\"Idaho\",\"isDisabled\":false},{\"label\":\"Illinois\",\"value\":\"Illinois\",\"isDisabled\":false},{\"label\":\"Indiana\",\"value\":\"Indiana\",\"isDisabled\":false},{\"label\":\"Kansas\",\"value\":\"Kansas\",\"isDisabled\":false},{\"label\":\"Kentucky\",\"value\":\"Kentucky\",\"isDisabled\":false},{\"label\":\"Louisiana\",\"value\":\"Louisiana\",\"isDisabled\":false},{\"label\":\"Massachusetts\",\"value\":\"Massachusetts\",\"isDisabled\":false},{\"label\":\"Maryland\",\"value\":\"Maryland\",\"isDisabled\":false},{\"label\":\"Maine\",\"value\":\"Maine\",\"isDisabled\":false},{\"label\":\"Marshall Islands\",\"value\":\"Marshall Islands\",\"isDisabled\":false},{\"label\":\"Michigan\",\"value\":\"Michigan\",\"isDisabled\":false},{\"label\":\"Minnesota\",\"value\":\"Minnesota\",\"isDisabled\":false},{\"label\":\"Missouri\",\"value\":\"Missouri\",\"isDisabled\":false},{\"label\":\"Marianas\",\"value\":\"Marianas\",\"isDisabled\":false},{\"label\":\"Mississippi\",\"value\":\"Mississippi\",\"isDisabled\":false},{\"label\":\"Montana\",\"value\":\"Montana\",\"isDisabled\":false},{\"label\":\"North Carolina\",\"value\":\"North Carolina\",\"isDisabled\":false},{\"label\":\"North Dakota\",\"value\":\"North Dakota\",\"isDisabled\":false},{\"label\":\"Nebraska\",\"value\":\"Nebraska\",\"isDisabled\":false},{\"label\":\"New Hampshire\",\"value\":\"New Hampshire\",\"isDisabled\":false},{\"label\":\"New Jersey\",\"value\":\"New Jersey\",\"isDisabled\":false},{\"label\":\"New Mexico\",\"value\":\"New Mexico\",\"isDisabled\":false},{\"label\":\"Nevada\",\"value\":\"Nevada\",\"isDisabled\":false},{\"label\":\"New York\",\"value\":\"New York\",\"isDisabled\":false},{\"label\":\"Ohio\",\"value\":\"Ohio\",\"isDisabled\":false},{\"label\":\"Oklahoma\",\"value\":\"Oklahoma\",\"isDisabled\":false},{\"label\":\"Oregon\",\"value\":\"Oregon\",\"isDisabled\":false},{\"label\":\"Pennsylvania\",\"value\":\"Pennsylvania\",\"isDisabled\":false},{\"label\":\"Puerto Rico\",\"value\":\"Puerto Rico\",\"isDisabled\":false},{\"label\":\"Palau\",\"value\":\"Palau\",\"isDisabled\":false},{\"label\":\"Rhode Island\",\"value\":\"Rhode Island\",\"isDisabled\":false},{\"label\":\"South Carolina\",\"value\":\"South Carolina\",\"isDisabled\":false},{\"label\":\"South Dakota\",\"value\":\"South Dakota\",\"isDisabled\":false},{\"label\":\"Tennessee\",\"value\":\"Tennessee\",\"isDisabled\":false},{\"label\":\"Texas\",\"value\":\"Texas\",\"isDisabled\":false},{\"label\":\"Utah\",\"value\":\"Utah\",\"isDisabled\":false},{\"label\":\"Virginia\",\"value\":\"Virginia\",\"isDisabled\":false},{\"label\":\"Virgin Islands\",\"value\":\"Virgin Islands\",\"isDisabled\":false},{\"label\":\"Vermont\",\"value\":\"Vermont\",\"isDisabled\":false},{\"label\":\"Washington\",\"value\":\"Washington\",\"isDisabled\":false},{\"label\":\"Wisconsin\",\"value\":\"Wisconsin\",\"isDisabled\":false},{\"label\":\"West Virginia\",\"value\":\"West Virginia\",\"isDisabled\":false},{\"label\":\"Wyoming\",\"value\":\"Wyoming\",\"isDisabled\":false},{\"label\":\"Armed Forces Americas\",\"value\":\"Armed Forces Americas\",\"isDisabled\":false},{\"label\":\"Armed Forces Europe\",\"value\":\"Armed Forces Europe\",\"isDisabled\":false},{\"label\":\"Armed Forces Pacific\",\"value\":\"Armed Forces Pacific\",\"isDisabled\":false},{\"label\":\"Alberta\",\"value\":\"Alberta\",\"isDisabled\":false},{\"label\":\"Manitoba\",\"value\":\"Manitoba\",\"isDisabled\":false},{\"label\":\"British Columbia\",\"value\":\"British Columbia\",\"isDisabled\":false},{\"label\":\"New Brunswick\",\"value\":\"New Brunswick\",\"isDisabled\":false},{\"label\":\"Newfoundland and Labrador\",\"value\":\"Newfoundland and Labrador\",\"isDisabled\":false},{\"label\":\"Nova Scotia\",\"value\":\"Nova Scotia\",\"isDisabled\":false},{\"label\":\"Northwest Territories\",\"value\":\"Northwest Territories\",\"isDisabled\":false},{\"label\":\"Nunavut\",\"value\":\"Nunavut\",\"isDisabled\":false},{\"label\":\"Ontario\",\"value\":\"Ontario\",\"isDisabled\":false},{\"label\":\"Prince Edward Island\",\"value\":\"Prince Edward Island\",\"isDisabled\":false},{\"label\":\"Quebec\",\"value\":\"Quebec\",\"isDisabled\":false},{\"label\":\"Saskatchewan\",\"value\":\"Saskatchewan\",\"isDisabled\":false},{\"label\":\"Yukon Territory\",\"value\":\"Yukon Territory\",\"isDisabled\":false},{\"label\":\"Outside North America\",\"value\":\"Outside North America\",\"isDisabled\":false}].filter(item => item.value === parent.getValue(\"mf-select_874478\"))[0] : []}\n                onChange=${(e)=> parent.handleSelect(e, \"mf-select_874478\")}\n                ref=${() => {\n\t\t\t\t                    register({ name: \"mf-select_874478\" }, parent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true}));\n                    if ( parent.getValue(\"mf-select_874478\") === '' && false ) {\n\t\t\t\t    parent.setValue( 'mf-select_874478', '', true );\n                        parent.handleChange({\n                            target: {\n                                name: 'mf-select_874478',\n                                value: ''\n                            }\n                        });\n                    }\n                }}\n                \/>\n\n            \t\t\t\t<${validation.ErrorMessage}\n\t\t\t\t\terrors=${validation.errors}\n\t\t\t\t\tname=\"mf-select_874478\"\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\n\t\t\t\t\t\/>\n\t\t\t\n            \t\t<\/div>\n\n\t\t\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section className=\"elementor-section elementor-inner-section elementor-element elementor-element-7e41dd3c elementor-section-boxed elementor-section-height-default elementor-section-height-default tf-sticky-section tf-sticky-no\" data-id=\"7e41dd3c\" data-element_type=\"section\" data-settings=\"{&quot;tf_sticky&quot;:&quot;no&quot;}\">\n\t\t\t\t\t\t<div className=\"elementor-container elementor-column-gap-extended\">\n\t\t\t\t\t<div className=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-d811fa1\" data-id=\"d811fa1\" data-element_type=\"column\">\n\t\t\t<div className=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div className=\"elementor-element elementor-element-43a7f344 elementor-widget elementor-widget-mf-text\" data-id=\"43a7f344\" data-element_type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-text_942485&quot;}\" data-widget_type=\"mf-text.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-text-43a7f344\">\r\n\t\t\t\t\t${ parent.decodeEntities(`Zip or Postal Code`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\r\n\t\t\t\t<\/label>\r\n\t\t\t\r\n\t\t\t<input\r\n\t\t\t\ttype=\"text\"\r\n\t\t\t\tclassName=\"mf-input \"\r\n\t\t\t\tid=\"mf-input-text-43a7f344\"\r\n\t\t\t\tname=\"mf-text_942485\"\r\n\t\t\t\tplaceholder=\"${ parent.decodeEntities(``) } \"\r\n\t\t\t\t\t\t\t\t\tonInput=${parent.handleChange}\r\n\t\t\t\t\taria-invalid=${validation.errors['mf-text_942485'] ? 'true' : 'false'}\r\n\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true,\"expression\":\"null\"}, el)\r\n\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\/>\r\n\r\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\r\n\t\t\t\t\terrors=${validation.errors}\r\n\t\t\t\t\tname=\"mf-text_942485\"\r\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\t\t\/>\r\n\t\t\t\r\n\t\t\t<span className=\"mf-input-help\">${ parent.decodeEntities(`For those in the United States, please enter first five digits only.\n`) } <\/span>\t\t<\/div>\r\n\r\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 className=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-2a9f386a\" data-id=\"2a9f386a\" data-element_type=\"column\">\n\t\t\t<div className=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div className=\"elementor-element elementor-element-1fe90d46 elementor-widget elementor-widget-mf-text\" data-id=\"1fe90d46\" data-element_type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-text_170701&quot;}\" data-widget_type=\"mf-text.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-text-1fe90d46\">\r\n\t\t\t\t\t${ parent.decodeEntities(`Business Phone`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\r\n\t\t\t\t<\/label>\r\n\t\t\t\r\n\t\t\t<input\r\n\t\t\t\ttype=\"text\"\r\n\t\t\t\tclassName=\"mf-input \"\r\n\t\t\t\tid=\"mf-input-text-1fe90d46\"\r\n\t\t\t\tname=\"mf-text_170701\"\r\n\t\t\t\tplaceholder=\"${ parent.decodeEntities(``) } \"\r\n\t\t\t\t\t\t\t\t\tonInput=${parent.handleChange}\r\n\t\t\t\t\taria-invalid=${validation.errors['mf-text_170701'] ? 'true' : 'false'}\r\n\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true,\"expression\":\"null\"}, el)\r\n\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\/>\r\n\r\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\r\n\t\t\t\t\terrors=${validation.errors}\r\n\t\t\t\t\tname=\"mf-text_170701\"\r\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\t\t\/>\r\n\t\t\t\r\n\t\t\t\t\t<\/div>\r\n\r\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 className=\"elementor-section elementor-inner-section elementor-element elementor-element-246241e9 elementor-section-boxed elementor-section-height-default elementor-section-height-default tf-sticky-section tf-sticky-no\" data-id=\"246241e9\" data-element_type=\"section\" data-settings=\"{&quot;tf_sticky&quot;:&quot;no&quot;}\">\n\t\t\t\t\t\t<div className=\"elementor-container elementor-column-gap-extended\">\n\t\t\t\t\t<div className=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-331e91e1\" data-id=\"331e91e1\" data-element_type=\"column\">\n\t\t\t<div className=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div className=\"elementor-element elementor-element-169f2466 elementor-widget elementor-widget-mf-select\" data-id=\"169f2466\" data-element_type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-select_900491&quot;,&quot;mf_input_list&quot;:[{&quot;mf_input_option_text&quot;:&quot;Yes&quot;,&quot;mf_input_option_value&quot;:&quot;Yes&quot;,&quot;_id&quot;:&quot;71231c6&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;No&quot;,&quot;mf_input_option_value&quot;:&quot;No&quot;,&quot;_id&quot;:&quot;7475b31&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;}]}\" data-widget_type=\"mf-select.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\n\t\t\n\t\t<div className=\"mf-input-wrapper\">\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-select-169f2466\">\n\t\t\t\t\t${ parent.decodeEntities(`Are you looking to change your preferred diagnostic testing provider in the next 6 months?*`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\n\t\t\t\t<\/label>\n            \n            <${props.Select}\n                className=${\"mf-input mf-input-select  \" + ( validation.errors['mf-select_900491'] ? 'mf-invalid' : '' )}\n                classNamePrefix=\"mf_select\"\n                name=\"mf-select_900491\"\n                placeholder=\"${ parent.decodeEntities(`Please Select`) } \"\n                isSearchable=${false}\n                options=${[{\"label\":\"Yes\",\"value\":\"Yes\",\"isDisabled\":false},{\"label\":\"No\",\"value\":\"No\",\"isDisabled\":false}]}\n                value=${parent.getValue(\"mf-select_900491\") ? [{\"label\":\"Yes\",\"value\":\"Yes\",\"isDisabled\":false},{\"label\":\"No\",\"value\":\"No\",\"isDisabled\":false}].filter(item => item.value === parent.getValue(\"mf-select_900491\"))[0] : []}\n                onChange=${(e)=> parent.handleSelect(e, \"mf-select_900491\")}\n                ref=${() => {\n\t\t\t\t                    register({ name: \"mf-select_900491\" }, parent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true}));\n                    if ( parent.getValue(\"mf-select_900491\") === '' && false ) {\n\t\t\t\t    parent.setValue( 'mf-select_900491', '', true );\n                        parent.handleChange({\n                            target: {\n                                name: 'mf-select_900491',\n                                value: ''\n                            }\n                        });\n                    }\n                }}\n                \/>\n\n            \t\t\t\t<${validation.ErrorMessage}\n\t\t\t\t\terrors=${validation.errors}\n\t\t\t\t\tname=\"mf-select_900491\"\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\n\t\t\t\t\t\/>\n\t\t\t\n            \t\t<\/div>\n\n\t\t\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 className=\"elementor-section elementor-inner-section elementor-element elementor-element-7b19c74 elementor-section-boxed elementor-section-height-default elementor-section-height-default tf-sticky-section tf-sticky-no\" data-id=\"7b19c74\" data-element_type=\"section\" data-settings=\"{&quot;tf_sticky&quot;:&quot;no&quot;}\">\n\t\t\t\t\t\t<div className=\"elementor-container elementor-column-gap-extended\">\n\t\t\t\t\t<div className=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-56e29c04\" data-id=\"56e29c04\" data-element_type=\"column\">\n\t\t\t<div className=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div className=\"elementor-element elementor-element-4da9852 elementor-widget elementor-widget-mf-textarea\" data-id=\"4da9852\" data-element_type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-textarea_222511&quot;}\" data-widget_type=\"mf-textarea.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-text-area-4da9852\">\r\n\t\t\t\t\t${ parent.decodeEntities(`Please provide a comment or question we might address with our reply:`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\r\n\t\t\t\t<\/label>\r\n\t\t\t\r\n\t\t\t<textarea className=\"mf-input mf-textarea \" id=\"mf-input-text-area-4da9852\"\r\n\t\t\t\tname=\"mf-textarea_222511\" \r\n\t\t\t\tplaceholder=\"${ parent.decodeEntities(``) } \"\r\n\t\t\t\tcols=\"30\" rows=\"10\"\r\n\t\t\t\t\t\t\t\t\tonInput=${ parent.handleChange }\r\n\t\t\t\t\taria-invalid=${validation.errors['mf-textarea_222511'] ? 'true' : 'false'}\r\n\t\t\t\t\tref=${ el => parent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true,\"expression\":\"null\"}, el)}\r\n\t\t\t\t\t\t\t\t><\/textarea>\r\n\r\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\r\n\t\t\t\t\terrors=${validation.errors}\r\n\t\t\t\t\tname=\"mf-textarea_222511\"\r\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\t\t\/>\r\n\t\t\t\r\n\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-74db23d3 mf-btn--left elementor-widget elementor-widget-mf-button\" data-id=\"74db23d3\" data-element_type=\"widget\" data-widget_type=\"mf-button.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\t\t<div className=\"mf-btn-wraper \" data-mf-form-conditional-logic-requirement=\"\">\r\n\t\t\t\t\t\t\t<button type=\"submit\" className=\"metform-btn metform-submit-btn \" id=\"\">\r\n\t\t\t\t\t<span>${ parent.decodeEntities(`Send Message`) } <\/span>\r\n\t\t\t\t<\/button>\r\n\t\t\t        <\/div>\r\n        \t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t`}\r\n\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t${is_dummy_markup ? message_position === 'bottom' ? props.ResponseDummyMarkup(message_successIcon, message_proClass) : '' : ''}\r\n\t\t\t\t\t${is_dummy_markup ? 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