{"id":5069,"date":"2026-07-15T17:20:33","date_gmt":"2026-07-15T17:20:33","guid":{"rendered":"http:\/\/223.30.218.166:8083\/npo_donation\/?page_id=5069"},"modified":"2026-08-21T15:22:09","modified_gmt":"2026-08-21T09:52:09","slug":"patient-referrals","status":"publish","type":"page","link":"http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/patient-referrals\/","title":{"rendered":"Patient Referrals"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"5069\" class=\"elementor elementor-5069\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5cf4a51 e-flex e-con-boxed e-con e-parent\" data-id=\"5cf4a51\" data-element_type=\"container\" data-e-type=\"container\" 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d=\"M201,10.6c0-0.1-4.4,1.2-6.3,2.2c-1.9,0.9-6.2,3.1-6.1,3.1c0.1,0.1,4.2-1.6,6.3-2.6\tS201,10.7,201,10.6z\"\/>\n\t<path class=\"elementor-shape-fill\" d=\"M154.5,26.7c-0.1-0.1-4.6,0.3-7.2,0c-7.3-0.7-17-3.2-16.6-2.9c0.4,0.3,13.7,3.1,17,3.3\tC152.6,27.5,154.6,26.8,154.5,26.7z\"\/>\n\t<path class=\"elementor-shape-fill\" d=\"M41.9,19.3c0,0,1.2-0.3,2.9-0.1c1.7,0.2,5.8,0.9,8.2,0.7c4.2-0.4,7.4-2.7,7-2.6\tc-0.4,0-4.3,2.2-8.6,1.9c-1.8-0.1-5.1-0.5-6.7-0.4S41.9,19.3,41.9,19.3z\"\/>\n\t<path class=\"elementor-shape-fill\" d=\"M75.5,12.6c0.2,0.1,2-0.8,4.3-1.1c2.3-0.2,2.1-0.3,2.1-0.5c0-0.1-1.8-0.4-3.4,0\tC76.9,11.5,75.3,12.5,75.5,12.6z\"\/>\n\t<path class=\"elementor-shape-fill\" d=\"M15.6,13.2c0-0.1,4.3,0,6.7,0.5c2.4,0.5,5,1.9,5,2c0,0.1-2.7-0.8-5.1-1.4\tC19.9,13.7,15.7,13.3,15.6,13.2z\"\/>\n<\/svg>\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-7b21ded e-con-full e-flex e-con e-child\" data-id=\"7b21ded\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8f53032 elementor-widget__width-inherit elementor-widget-mobile__width-inherit elementor-invisible elementor-widget elementor-widget-heading\" data-id=\"8f53032\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeIn&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Patient <b class=\"heading-font\" style=\"color:#e12454\">Referrals Made<\/b> Simple<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8569f96 elementor-widget__width-initial elementor-widget-tablet__width-inherit elementor-widget-mobile__width-inherit elementor-widget elementor-widget-text-editor\" data-id=\"8569f96\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>We work closely with physicians, specialists, and healthcare providers to ensure patients receive timely referrals, coordinated care, and access to the right medical expertise for their healthcare needs.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-68b993e e-con-full elementor-hidden-tablet e-flex e-con e-child\" data-id=\"68b993e\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-4d6f5b0 elementor-hidden-desktop elementor-hidden-tablet elementor-hidden-mobile e-flex e-con-boxed e-con e-parent\" data-id=\"4d6f5b0\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-322aeb8 e-con-full e-flex e-con e-child\" data-id=\"322aeb8\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-54b93ce elementor-widget elementor-widget-heading\" data-id=\"54b93ce\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">How the Referral <b class=\"heading-font\" style=\"color:#e12454\">Process Works<\/b><\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fa5f911 elementor-position-inline-start elementor-view-default elementor-mobile-position-block-start elementor-widget elementor-widget-icon-box\" data-id=\"fa5f911\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<span  class=\"elementor-icon elementor-animation-buzz\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-diagnoses\" viewBox=\"0 0 640 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M496 256c8.8 0 16-7.2 16-16s-7.2-16-16-16-16 7.2-16 16 7.2 16 16 16zm-176-80c48.5 0 88-39.5 88-88S368.5 0 320 0s-88 39.5-88 88 39.5 88 88 88zM59.8 364c10.2 15.3 29.3 17.8 42.9 9.8 16.2-9.6 56.2-31.7 105.3-48.6V416h224v-90.7c49.1 16.8 89.1 39 105.3 48.6 13.6 8 32.7 5.3 42.9-9.8l17.8-26.7c8.8-13.2 7.6-34.6-10-45.1-11.9-7.1-29.7-17-51.1-27.4-28.1 46.1-99.4 17.8-87.7-35.1C409.3 217.2 365.1 208 320 208c-57 0-112.9 14.5-160 32.2-.2 40.2-47.6 63.3-79.2 36-11.2 6-21.3 11.6-28.7 16-17.6 10.5-18.8 31.8-10 45.1L59.8 364zM368 344c13.3 0 24 10.7 24 24s-10.7 24-24 24-24-10.7-24-24 10.7-24 24-24zm-96-96c13.3 0 24 10.7 24 24s-10.7 24-24 24-24-10.7-24-24 10.7-24 24-24zm-160 8c8.8 0 16-7.2 16-16s-7.2-16-16-16-16 7.2-16 16 7.2 16 16 16zm512 192H16c-8.8 0-16 7.2-16 16v32c0 8.8 7.2 16 16 16h608c8.8 0 16-7.2 16-16v-32c0-8.8-7.2-16-16-16z\"><\/path><\/svg>\t\t\t\t<\/span>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<h3 class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<span  >\n\t\t\t\t\t\t\tSubmit a Referral\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<p class=\"elementor-icon-box-description\">\n\t\t\t\t\t\tComplete the referral form with the patient's medical details.\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5c6308e elementor-position-inline-start elementor-view-default elementor-mobile-position-block-start elementor-widget elementor-widget-icon-box\" data-id=\"5c6308e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<span  class=\"elementor-icon elementor-animation-buzz\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-hand-holding-medical\" viewBox=\"0 0 576 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M159.88,175.82h64v64a16,16,0,0,0,16,16h64a16,16,0,0,0,16-16v-64h64a16,16,0,0,0,16-16v-64a16,16,0,0,0-16-16h-64v-64a16,16,0,0,0-16-16h-64a16,16,0,0,0-16,16v64h-64a16,16,0,0,0-16,16v64A16,16,0,0,0,159.88,175.82ZM568.07,336.13a39.91,39.91,0,0,0-55.93-8.47L392.47,415.84H271.86a16,16,0,0,1,0-32H350.1c16,0,30.75-10.87,33.37-26.61a32.06,32.06,0,0,0-31.62-37.38h-160a117.7,117.7,0,0,0-74.12,26.25l-46.5,37.74H15.87a16.11,16.11,0,0,0-16,16v96a16.11,16.11,0,0,0,16,16h347a104.8,104.8,0,0,0,61.7-20.27L559.6,392A40,40,0,0,0,568.07,336.13Z\"><\/path><\/svg>\t\t\t\t<\/span>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<h3 class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<span  >\n\t\t\t\t\t\t\tReferral Review\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<p class=\"elementor-icon-box-description\">\n\t\t\t\t\t\tOur care team reviews the information and coordinates with the appropriate specialist.\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-de1294e elementor-position-inline-start elementor-view-default elementor-mobile-position-block-start elementor-widget elementor-widget-icon-box\" data-id=\"de1294e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<span  class=\"elementor-icon elementor-animation-buzz\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-book-medical\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M448 358.4V25.6c0-16-9.6-25.6-25.6-25.6H96C41.6 0 0 41.6 0 96v320c0 54.4 41.6 96 96 96h326.4c12.8 0 25.6-9.6 25.6-25.6v-16q0-9.6-9.6-19.2c-3.2-16-3.2-60.8 0-73.6q9.6-4.8 9.6-19.2zM144 168a8 8 0 0 1 8-8h56v-56a8 8 0 0 1 8-8h48a8 8 0 0 1 8 8v56h56a8 8 0 0 1 8 8v48a8 8 0 0 1-8 8h-56v56a8 8 0 0 1-8 8h-48a8 8 0 0 1-8-8v-56h-56a8 8 0 0 1-8-8zm236.8 280H96c-19.2 0-32-12.8-32-32s16-32 32-32h284.8z\"><\/path><\/svg>\t\t\t\t<\/span>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<h3 class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<span  >\n\t\t\t\t\t\t\tAppointment Scheduling\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<p class=\"elementor-icon-box-description\">\n\t\t\t\t\t\tThe patient is contacted to schedule a consultation at the earliest available time.\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0ee52da elementor-position-inline-start elementor-view-default elementor-mobile-position-block-start elementor-widget elementor-widget-icon-box\" data-id=\"0ee52da\" 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7.1 22.3 5 45 4.8 66.2 0 3.3-.7 5.7-3.7 5.7-7.1v-29.8c13.5-4.8 26-12 36.9-21.3l25.8 14.9c2.9 1.7 6.7 1.1 9-1.4 15-16.2 26.5-35.8 33.2-57.4 1-3.3-.4-6.8-3.3-8.5l-25.8-14.9zM496 368.5c-26.8 0-48.5-21.8-48.5-48.5s21.8-48.5 48.5-48.5 48.5 21.8 48.5 48.5-21.7 48.5-48.5 48.5zM96 224c35.3 0 64-28.7 64-64s-28.7-64-64-64-64 28.7-64 64 28.7 64 64 64zm224 32c1.9 0 3.7-.5 5.6-.6 8.3-21.7 20.5-42.1 36.3-59.2 7.4-8 17.9-12.6 28.9-12.6 6.9 0 13.7 1.8 19.6 5.3l7.9 4.6c.8-.5 1.6-.9 2.4-1.4 7-14.6 11.2-30.8 11.2-48 0-61.9-50.1-112-112-112S208 82.1 208 144c0 61.9 50.1 112 112 112zm105.2 194.5c-2.3-1.2-4.6-2.6-6.8-3.9-8.2 4.8-15.3 9.8-27.5 9.8-10.9 0-21.4-4.6-28.9-12.6-18.3-19.8-32.3-43.9-40.2-69.6-10.7-34.5 24.9-49.7 25.8-50.3-.1-2.6-.1-5.2 0-7.8l-7.9-4.6c-3.8-2.2-7-5-9.8-8.1-3.3.2-6.5.6-9.8.6-24.6 0-47.6-6-68.5-16h-8.3C179.6 288 128 339.6 128 403.2V432c0 26.5 21.5 48 48 48h255.4c-3.7-6-6.2-12.8-6.2-20.3v-9.2zM173.1 274.6C161.5 263.1 145.6 256 128 256H64c-35.3 0-64 28.7-64 64v32c0 17.7 14.3 32 32 32h65.9c6.3-47.4 34.9-87.3 75.2-109.4z\"><\/path><\/svg>\t\t\t\t<\/span>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<h3 class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<span  >\n\t\t\t\t\t\t\tOngoing Care\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<p class=\"elementor-icon-box-description\">\n\t\t\t\t\t\tOur specialists provide treatment and keep the referring provider informed throughout the patient's care journey.\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-9fbacd8 e-con-full e-flex e-con e-child\" data-id=\"9fbacd8\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7f2d908 animation-img-1 premium-floating-effects-yes elementor-widget elementor-widget-image\" data-id=\"7f2d908\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;premium_fe_trigger&quot;:&quot;hover&quot;,&quot;premium_fe_direction&quot;:&quot;normal&quot;,&quot;premium_fe_easing&quot;:&quot;easeInOutElastic(1, .6)&quot;,&quot;premium_fe_loop&quot;:&quot;default&quot;}\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"1024\" height=\"1024\" src=\"http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/08\/How-the-Referral.png\" class=\"attachment-large size-large wp-image-17927\" alt=\"\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-3b99eb8 e-flex e-con-boxed e-con e-parent\" data-id=\"3b99eb8\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-e137ac4 e-con-full e-flex e-con e-child\" data-id=\"e137ac4\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6333bfb elementor-widget elementor-widget-heading\" data-id=\"6333bfb\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">How the Referral <b class=\"heading-font\" style=\"color:#e12454\">Process Works<\/b><\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2803792 elementor-widget__width-initial elementor-widget-tablet__width-inherit elementor-widget elementor-widget-image\" data-id=\"2803792\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"704\" height=\"780\" src=\"http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/08\/2222222.png\" class=\"attachment-large size-large wp-image-17954\" alt=\"\" srcset=\"http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/08\/2222222.png 704w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/08\/2222222-271x300.png 271w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/08\/2222222-238x264.png 238w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/08\/2222222-600x665.png 600w\" sizes=\"(max-width: 704px) 100vw, 704px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-82b549b e-con-full e-flex e-con e-child\" data-id=\"82b549b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-cc0c1f0 animation-img-1 premium-floating-effects-yes elementor-widget elementor-widget-image\" data-id=\"cc0c1f0\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;premium_fe_trigger&quot;:&quot;hover&quot;,&quot;premium_fe_direction&quot;:&quot;normal&quot;,&quot;premium_fe_easing&quot;:&quot;easeInOutElastic(1, .6)&quot;,&quot;premium_fe_loop&quot;:&quot;default&quot;}\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"783\" height=\"829\" src=\"http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/08\/111111111.jpg\" class=\"attachment-large size-large wp-image-17950\" alt=\"\" srcset=\"http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/08\/111111111.jpg 783w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/08\/111111111-283x300.jpg 283w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/08\/111111111-768x813.jpg 768w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/08\/111111111-249x264.jpg 249w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/08\/111111111-600x635.jpg 600w\" sizes=\"(max-width: 783px) 100vw, 783px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-790d337 e-flex e-con-boxed e-con e-parent\" data-id=\"790d337\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;shape_divider_top&quot;:&quot;curve&quot;,&quot;shape_divider_bottom&quot;:&quot;curve-asymmetrical&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-shape elementor-shape-top\" aria-hidden=\"true\" data-negative=\"false\">\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 1000 100\" preserveAspectRatio=\"none\">\n    <path class=\"elementor-shape-fill\" d=\"M1000,4.3V0H0v4.3C0.9,23.1,126.7,99.2,500,100S1000,22.7,1000,4.3z\"\/>\n<\/svg>\t\t<\/div>\n\t\t\t\t<div class=\"elementor-shape elementor-shape-bottom\" aria-hidden=\"true\" data-negative=\"false\">\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 1000 100\" preserveAspectRatio=\"none\">\n\t<path class=\"elementor-shape-fill\" d=\"M0,0c0,0,0,6,0,6.7c0,18,240.2,93.6,615.2,92.6C989.8,98.5,1000,25,1000,6.7c0-0.7,0-6.7,0-6.7H0z\"\/>\n<\/svg>\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0ea564c elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"0ea564c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Why Healthcare <b class=\"heading-font\" style=\"color:#e12454\">Providers Choose Us<\/b><\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d8de43a elementor-widget__width-initial elementor-widget-tablet__width-inherit elementor-widget-mobile__width-inherit elementor-widget elementor-widget-text-editor\" data-id=\"d8de43a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>We collaborate with physicians and healthcare organizations to deliver timely appointments, expert consultations, and comprehensive treatment plans.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-60b40e4 e-con-full e-flex e-con e-child\" data-id=\"60b40e4\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-c2a8b53 e-grid e-con-full e-con e-child\" data-id=\"c2a8b53\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-aa9f4e7 elementor-widget elementor-widget-premium-addon-banner\" data-id=\"aa9f4e7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"premium-addon-banner.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"premium-banner-ib premium-banner-min-height premium-banner-animation11 sepia premium-banner__effect-type2\">\n\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"1000\" height=\"1000\" src=\"http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Experienced-Pediatric-Specialists.jpg\" class=\"attachment-full size-full wp-image-5121\" alt=\"Experienced Pediatric Specialists\" srcset=\"http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Experienced-Pediatric-Specialists.jpg 1000w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Experienced-Pediatric-Specialists-300x300.jpg 300w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Experienced-Pediatric-Specialists-100x100.jpg 100w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Experienced-Pediatric-Specialists-600x600.jpg 600w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Experienced-Pediatric-Specialists-150x150.jpg 150w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Experienced-Pediatric-Specialists-768x768.jpg 768w\" sizes=\"(max-width: 1000px) 100vw, 1000px\" \/>\t\t\t\t\t\t\t\t\t\t<div class=\"premium-banner-gradient\"><\/div>\n\t\t\t\t\t\t<div class=\"premium-banner-ib-desc\">\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<h3 class=\"premium-banner-ib-title premium_banner_title\">\n\t\t\t\t\t\tExperienced Pediatric Specialists\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-422d6ef elementor-widget elementor-widget-premium-addon-banner\" data-id=\"422d6ef\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"premium-addon-banner.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"premium-banner-ib premium-banner-min-height premium-banner-animation11 none premium-banner__effect-type2\">\n\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"1000\" height=\"1000\" src=\"http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Advanced-Diagnostic-Services.jpg\" class=\"attachment-full size-full wp-image-5125\" alt=\"Advanced Diagnostic Services\" srcset=\"http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Advanced-Diagnostic-Services.jpg 1000w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Advanced-Diagnostic-Services-300x300.jpg 300w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Advanced-Diagnostic-Services-100x100.jpg 100w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Advanced-Diagnostic-Services-600x600.jpg 600w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Advanced-Diagnostic-Services-150x150.jpg 150w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Advanced-Diagnostic-Services-768x768.jpg 768w\" sizes=\"(max-width: 1000px) 100vw, 1000px\" \/>\t\t\t\t\t\t\t\t\t\t<div class=\"premium-banner-gradient\"><\/div>\n\t\t\t\t\t\t<div class=\"premium-banner-ib-desc\">\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<h3 class=\"premium-banner-ib-title premium_banner_title\">\n\t\t\t\t\t\tAdvanced Diagnostic Services\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-aaf8c26 elementor-widget elementor-widget-premium-addon-banner\" data-id=\"aaf8c26\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"premium-addon-banner.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"premium-banner-ib premium-banner-min-height premium-banner-animation11 none premium-banner__effect-type2\">\n\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"1000\" height=\"1000\" src=\"http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Fast-Appointment-Scheduling.jpg\" class=\"attachment-full size-full wp-image-5126\" alt=\"Fast Appointment Scheduling\" srcset=\"http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Fast-Appointment-Scheduling.jpg 1000w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Fast-Appointment-Scheduling-300x300.jpg 300w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Fast-Appointment-Scheduling-100x100.jpg 100w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Fast-Appointment-Scheduling-600x600.jpg 600w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Fast-Appointment-Scheduling-150x150.jpg 150w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Fast-Appointment-Scheduling-768x768.jpg 768w\" sizes=\"(max-width: 1000px) 100vw, 1000px\" \/>\t\t\t\t\t\t\t\t\t\t<div class=\"premium-banner-gradient\"><\/div>\n\t\t\t\t\t\t<div class=\"premium-banner-ib-desc\">\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<h3 class=\"premium-banner-ib-title premium_banner_title\">\n\t\t\t\t\t\tFast Appointment Scheduling\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7ec61c1 elementor-widget elementor-widget-premium-addon-banner\" data-id=\"7ec61c1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"premium-addon-banner.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"premium-banner-ib premium-banner-min-height premium-banner-animation11 none premium-banner__effect-type2\">\n\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"1000\" height=\"1000\" src=\"http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Multidisciplinary-Care-Team.jpg\" class=\"attachment-full size-full wp-image-5127\" alt=\"Multidisciplinary Care Team\" srcset=\"http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Multidisciplinary-Care-Team.jpg 1000w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Multidisciplinary-Care-Team-300x300.jpg 300w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Multidisciplinary-Care-Team-100x100.jpg 100w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Multidisciplinary-Care-Team-600x600.jpg 600w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Multidisciplinary-Care-Team-150x150.jpg 150w, http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-content\/uploads\/2026\/07\/Multidisciplinary-Care-Team-768x768.jpg 768w\" sizes=\"(max-width: 1000px) 100vw, 1000px\" \/>\t\t\t\t\t\t\t\t\t\t<div class=\"premium-banner-gradient\"><\/div>\n\t\t\t\t\t\t<div class=\"premium-banner-ib-desc\">\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<h3 class=\"premium-banner-ib-title premium_banner_title\">\n\t\t\t\t\t\tMultidisciplinary Care Team\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-2fbd8ef7 e-flex e-con-boxed e-con e-parent\" data-id=\"2fbd8ef7\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3f2889b elementor-widget elementor-widget-heading\" data-id=\"3f2889b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Online <b class=\"heading-font\" style=\"color:#e12454\">Referral<\/b> Form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7356762 elementor-widget elementor-widget-text-editor\" data-id=\"7356762\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<ul><li>Name and contact information of the care provider making the referral<\/li><li>Patient\u2019s name<\/li><li>Patient\u2019s date of birth<\/li><li>Patient\u2019s address and phone number<\/li><li>Patient diagnosis and treatment history<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a1280a5 elementor-widget elementor-widget-heading\" data-id=\"a1280a5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h5 class=\"elementor-heading-title elementor-size-default\">Patient Information<\/h5>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-abd4b3f elementor-button-align-center elementor-mobile-button-align-stretch elementor-widget__width-inherit elementor-widget elementor-widget-form\" data-id=\"abd4b3f\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"New Form\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"5069\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"abd4b3f\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Patient Referrals\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"5069\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPatient's Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"First Name\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_29671c0 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_29671c0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLast Name \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_29671c0]\" id=\"form-field-field_29671c0\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Last Name \">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEmail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Email\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_be8d080 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_be8d080\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPatient's Preferred Name \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_be8d080]\" id=\"form-field-field_be8d080\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_2e0731a elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2e0731a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPatient's Address \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_2e0731a]\" id=\"form-field-field_2e0731a\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Address Line 1\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_68aa6da elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_68aa6da\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAddress Line 2\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_68aa6da]\" id=\"form-field-field_68aa6da\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Address Line 2\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_719d088 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_719d088\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCity\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_719d088]\" id=\"form-field-field_719d088\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"City\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_e3cf6c3 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e3cf6c3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tState \/ Province\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_e3cf6c3]\" id=\"form-field-field_e3cf6c3\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"State \/ Province\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_36ea0fb elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_36ea0fb\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPostal \/ Zip Code\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_36ea0fb]\" id=\"form-field-field_36ea0fb\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Postal \/ Zip Code\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_2c31b4c elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2c31b4c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCountry\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-eicon-caret-down\" viewBox=\"0 0 571.4 571.4\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M571 393Q571 407 561 418L311 668Q300 679 286 679T261 668L11 418Q0 407 0 393T11 368 36 357H536Q550 357 561 368T571 393Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_2c31b4c]\" id=\"form-field-field_2c31b4c\" class=\"elementor-field-textual elementor-size-sm\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t<option value=\"Please select\">Please select<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Afghanistan\">Afghanistan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Albania\">Albania<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Algeria\">Algeria<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Andorra\">Andorra<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Angola\">Angola<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Antigua and Barbuda\">Antigua and Barbuda<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Argentina\">Argentina<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Armenia\">Armenia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Australia\">Australia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Austria\">Austria<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Azerbaijan\">Azerbaijan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bahamas\">Bahamas<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bahrain\">Bahrain<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bangladesh\">Bangladesh<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Barbados\">Barbados<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Belarus\">Belarus<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Belgium\">Belgium<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Belize\">Belize<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Benin\">Benin<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bhutan\">Bhutan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bolivia\">Bolivia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Botswana\">Botswana<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Brazil\">Brazil<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Brunei\">Brunei<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bulgaria\">Bulgaria<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Burkina Faso\">Burkina Faso<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Burundi\">Burundi<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cabo Verde\">Cabo Verde<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cambodia\">Cambodia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cameroon\">Cameroon<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Canada\">Canada<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Central African Republic\">Central African Republic<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Chad\">Chad<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Chile\">Chile<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"China\">China<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Colombia\">Colombia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Comoros\">Comoros<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Congo\">Congo<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Costa Rica\">Costa Rica<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Croatia\">Croatia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cuba\">Cuba<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cyprus\">Cyprus<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Czech Republic\">Czech Republic<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Democratic Republic of the Congo\">Democratic Republic of the Congo<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Denmark\">Denmark<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Djibouti\">Djibouti<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Dominica\">Dominica<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Dominican Republic\">Dominican Republic<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ecuador\">Ecuador<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Egypt\">Egypt<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"El Salvador\">El Salvador<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Equatorial Guinea\">Equatorial Guinea<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Eritrea\">Eritrea<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Estonia\">Estonia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Eswatini\">Eswatini<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ethiopia\">Ethiopia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Fiji\">Fiji<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Finland\">Finland<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"France\">France<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Gabon\">Gabon<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Gambia\">Gambia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Georgia\">Georgia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Germany\">Germany<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ghana\">Ghana<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Greece\">Greece<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Grenada\">Grenada<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Guatemala\">Guatemala<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Guinea\">Guinea<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Guinea-Bissau\">Guinea-Bissau<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Guyana\">Guyana<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Haiti\">Haiti<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Honduras\">Honduras<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Hungary\">Hungary<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Iceland\">Iceland<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"India\">India<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Indonesia\">Indonesia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Iran\">Iran<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Iraq\">Iraq<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ireland\">Ireland<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Israel\">Israel<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Italy\">Italy<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ivory Coast\">Ivory Coast<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Jamaica\">Jamaica<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Japan\">Japan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Jordan\">Jordan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kazakhstan\">Kazakhstan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kenya\">Kenya<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kiribati\">Kiribati<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kuwait\">Kuwait<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kyrgyzstan\">Kyrgyzstan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Laos\">Laos<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Latvia\">Latvia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Lebanon\">Lebanon<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Lesotho\">Lesotho<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Liberia\">Liberia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Libya\">Libya<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Liechtenstein\">Liechtenstein<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Lithuania\">Lithuania<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Luxembourg\">Luxembourg<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Madagascar\">Madagascar<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Malawi\">Malawi<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Malaysia\">Malaysia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Maldives\">Maldives<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mali\">Mali<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Malta\">Malta<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Marshall Islands\">Marshall Islands<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mauritania\">Mauritania<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mauritius\">Mauritius<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mexico\">Mexico<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Micronesia\">Micronesia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Moldova\">Moldova<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Monaco\">Monaco<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mongolia\">Mongolia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Montenegro\">Montenegro<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Morocco\">Morocco<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mozambique\">Mozambique<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Myanmar\">Myanmar<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Namibia\">Namibia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nauru\">Nauru<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nepal\">Nepal<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Netherlands\">Netherlands<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"New Zealand\">New Zealand<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nicaragua\">Nicaragua<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Niger\">Niger<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nigeria\">Nigeria<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"North Korea\">North Korea<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"North Macedonia\">North Macedonia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Norway\">Norway<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Oman\">Oman<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Pakistan\">Pakistan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Palau\">Palau<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Palestine\">Palestine<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Panama\">Panama<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Papua New Guinea\">Papua New Guinea<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Paraguay\">Paraguay<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Peru\">Peru<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Philippines\">Philippines<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Poland\">Poland<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Portugal\">Portugal<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Qatar\">Qatar<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Romania\">Romania<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Russia\">Russia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Rwanda\">Rwanda<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Saint Lucia\">Saint Lucia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Saint Vincent and the Grenadines\">Saint Vincent and the Grenadines<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Samoa\">Samoa<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"San Marino\">San Marino<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Sao Tome and Principe\">Sao Tome and Principe<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Saudi Arabia\">Saudi Arabia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Senegal\">Senegal<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Serbia\">Serbia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Seychelles\">Seychelles<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Sierra Leone\">Sierra Leone<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Singapore\">Singapore<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Slovakia\">Slovakia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Slovenia\">Slovenia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Solomon Islands\">Solomon Islands<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Somalia\">Somalia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"South Africa\">South Africa<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"South Korea\">South Korea<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"South Sudan\">South Sudan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Spain\">Spain<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Sri Lanka\">Sri Lanka<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Sudan\">Sudan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Suriname\">Suriname<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Sweden\">Sweden<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Switzerland\">Switzerland<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Syria\">Syria<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Taiwan\">Taiwan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tajikistan\">Tajikistan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tanzania\">Tanzania<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Thailand\">Thailand<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Timor-Leste\">Timor-Leste<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Togo\">Togo<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tonga\">Tonga<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Trinidad and Tobago\">Trinidad and Tobago<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tunisia\">Tunisia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Turkey\">Turkey<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Turkmenistan\">Turkmenistan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tuvalu\">Tuvalu<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Uganda\">Uganda<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ukraine\">Ukraine<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"United Arab Emirates\">United Arab Emirates<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"United Kingdom\">United Kingdom<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"United States\">United States<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Uruguay\">Uruguay<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Uzbekistan\">Uzbekistan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Vanuatu\">Vanuatu<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Vatican City\">Vatican City<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Venezuela\">Venezuela<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Vietnam\">Vietnam<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yemen\">Yemen<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Zambia\">Zambia<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Zimbabwe\">Zimbabwe<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_082af99 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_082af99\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPatient's Gender Identity \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Male\" id=\"form-field-field_082af99-0\" name=\"form_fields[field_082af99]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_082af99-0\">Male<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Female\" id=\"form-field-field_082af99-1\" name=\"form_fields[field_082af99]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_082af99-1\">Female<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Other\" id=\"form-field-field_082af99-2\" name=\"form_fields[field_082af99]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_082af99-2\">Other<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"I prefer not to answer\" id=\"form-field-field_082af99-3\" name=\"form_fields[field_082af99]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_082af99-3\">I prefer not to answer<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_a321a32 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a321a32\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPatient's Date of Birth\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_a321a32]\" id=\"form-field-field_a321a32\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field elementor-use-native\" required=\"required\" aria-required=\"true\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\" min=\"2019-07-01\" max=\"2031-07-01\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-message elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-message\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPatient's Diagnosis\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[message]\" id=\"form-field-message\" rows=\"4\" placeholder=\"Message\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_c43e4f5 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c43e4f5\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate of Diagnosis \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_c43e4f5]\" id=\"form-field-field_c43e4f5\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field elementor-use-native\" required=\"required\" aria-required=\"true\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\" min=\"2021-07-01\" max=\"2035-07-01\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_946445e elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_946445e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHas the patient received any treatment?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_946445e-0\" name=\"form_fields[field_946445e]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_946445e-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_946445e-1\" name=\"form_fields[field_946445e]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_946445e-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_ddbe46d elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ddbe46d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHas the patient had any surgeries? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_ddbe46d-0\" name=\"form_fields[field_ddbe46d]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_ddbe46d-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_ddbe46d-1\" name=\"form_fields[field_ddbe46d]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_ddbe46d-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_8d95187 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8d95187\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHow would you like CHH to help you? Please include any details about this patient that would be helpful for our team to consider.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_8d95187]\" id=\"form-field-field_8d95187\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-pname elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-pname\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tParent\/Guardian's Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[pname]\" id=\"form-field-pname\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"First Name\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_392a795 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_392a795\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLast Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_392a795]\" id=\"form-field-field_392a795\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Last Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_bcb3962 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bcb3962\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tParent\/Guardian's Phone Number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_bcb3962]\" id=\"form-field-field_bcb3962\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Phone Number\" required=\"required\" aria-required=\"true\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_c3b5990 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c3b5990\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPhysician's Name \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_c3b5990]\" id=\"form-field-field_c3b5990\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"First Name\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_aa43ddd elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_aa43ddd\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLast Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_aa43ddd]\" id=\"form-field-field_aa43ddd\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Last Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_68af196 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_68af196\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPhysician's Address\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_68af196]\" id=\"form-field-field_68af196\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Address Line 1\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ae2e308 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ae2e308\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAddress Line 2\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ae2e308]\" id=\"form-field-field_ae2e308\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Address Line 2\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ae35737 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ae35737\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCity\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ae35737]\" id=\"form-field-field_ae35737\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"City\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_b64a759 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b64a759\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tState \/ Province\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_b64a759]\" id=\"form-field-field_b64a759\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"State \/ Province\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_bcb292d elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bcb292d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPostal \/ Zip Code\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_bcb292d]\" id=\"form-field-field_bcb292d\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Postal \/ Zip Code\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_bcb3962 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bcb3962\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPhysician's Phone Number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_bcb3962]\" id=\"form-field-field_bcb3962\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Please enter a valid phone number\" required=\"required\" aria-required=\"true\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_bcb3962 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bcb3962\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFax Number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_bcb3962]\" id=\"form-field-field_bcb3962\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Please enter a valid phone number.\" required=\"required\" aria-required=\"true\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_7848e25 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7848e25\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPhysician's Email \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_7848e25]\" id=\"form-field-field_7848e25\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"example@example.com\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_05a5e9b elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_05a5e9b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat led to your interest in a referral? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Recommended by a doctor or healthcare provider\" id=\"form-field-field_05a5e9b-0\" name=\"form_fields[field_05a5e9b][]\"> <label for=\"form-field-field_05a5e9b-0\">Recommended by a doctor or healthcare provider<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Referred by a hospital or medical center\" id=\"form-field-field_05a5e9b-1\" name=\"form_fields[field_05a5e9b][]\"> <label for=\"form-field-field_05a5e9b-1\">Referred by a hospital or medical center<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Suggested by a family member or friend\" id=\"form-field-field_05a5e9b-2\" name=\"form_fields[field_05a5e9b][]\"> <label for=\"form-field-field_05a5e9b-2\">Suggested by a family member or friend<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Found through an online search\" id=\"form-field-field_05a5e9b-3\" name=\"form_fields[field_05a5e9b][]\"> <label for=\"form-field-field_05a5e9b-3\">Found through an online search<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Learned from our website\" id=\"form-field-field_05a5e9b-4\" name=\"form_fields[field_05a5e9b][]\"> <label for=\"form-field-field_05a5e9b-4\">Learned from our website<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Community health awareness program\" id=\"form-field-field_05a5e9b-5\" name=\"form_fields[field_05a5e9b][]\"> <label for=\"form-field-field_05a5e9b-5\">Community health awareness program<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"School or community organizationHealthcare volunteer recommendation\" id=\"form-field-field_05a5e9b-6\" name=\"form_fields[field_05a5e9b][]\"> <label for=\"form-field-field_05a5e9b-6\">School or community organizationHealthcare volunteer recommendation<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_636e590 elementor-col-100 elementor-md-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_636e590\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tI agree to share my information with Child Health & Hospital.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"This service is operated by Child Health &amp; Hospital to help review and process referral requests.\" id=\"form-field-field_636e590-0\" name=\"form_fields[field_636e590]\"> <label for=\"form-field-field_636e590-0\">This service is operated by Child Health & Hospital to help review and process referral requests.<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-md\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Submit<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-3588d9ab e-con-full elementor-hidden-desktop elementor-hidden-tablet elementor-hidden-mobile e-flex e-con e-parent\" data-id=\"3588d9ab\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-1dc3e413 e-con-full e-flex e-con e-child\" data-id=\"1dc3e413\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-28a901ec elementor-widget-tablet__width-inherit elementor-widget-mobile__width-inherit elementor-widget elementor-widget-image-box\" data-id=\"28a901ec\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\">Need Referral Assistance?<\/h3><p class=\"elementor-image-box-description\">Our dedicated referral coordinators are available to assist healthcare providers, answer questions, and ensure a smooth referral experience from start to finish.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-6f679c20 e-con-full e-flex e-con e-child\" data-id=\"6f679c20\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-69541992 elementor-widget-tablet__width-initial elementor-widget-mobile__width-inherit elementor-widget elementor-widget-heading\" data-id=\"69541992\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Get in Touch<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-81bf8f2 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"81bf8f2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"tel:19175550165\">\n\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">+1 (917) 555-0165<\/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\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"mailto:referrals@hospitalname.com\">\n\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">referrals@hospitalname.com<\/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\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-55ca41bd e-con-full e-flex e-con e-child\" data-id=\"55ca41bd\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5f890c3b elementor-widget-tablet__width-initial elementor-widget-mobile__width-inherit elementor-widget elementor-widget-heading\" data-id=\"5f890c3b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Address<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e517709 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"e517709\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">262 Danny Thomas PlaceMemphis, TN 38105<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-66bf432a e-con-full e-flex e-con e-child\" data-id=\"66bf432a\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-506087d2 elementor-widget-tablet__width-initial elementor-widget-mobile__width-inherit elementor-widget elementor-widget-heading\" data-id=\"506087d2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Hours<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4d1cd549 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"4d1cd549\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Hours: Monday \u2013 Saturday<\/span>\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\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">8:00 AM \u2013 6:00 PM<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1c2c508 elementor-mobile-align-justify elementor-widget elementor-widget-button\" data-id=\"1c2c508\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"http:\/\/223.30.218.166:8083\/npo_donation\/contact-appointment\/\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Contact Referral<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6cc16617 elementor-absolute elementor-hidden-tablet elementor-hidden-mobile elementor-view-default elementor-widget elementor-widget-icon\" data-id=\"6cc16617\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_position&quot;:&quot;absolute&quot;}\" data-widget_type=\"icon.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<div 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class=\"woocommerce\"><div class=\"woocommerce-info\">Please log in first? <a class=\"wpneoShowLogin\" href=\"#\">Click here to login<\/a><\/div><div class=\"wpneo_login_form_div\" style=\"display: none;\"><form name=\"loginform\" id=\"loginform\" action=\"http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-login.php\" method=\"post\"><p class=\"login-username\">\n\t\t\t\t<label for=\"user_login\">Username or Email Address<\/label>\n\t\t\t\t<input type=\"text\" name=\"log\" id=\"user_login\" autocomplete=\"username\" class=\"input\" value=\"\" size=\"20\" \/>\n\t\t\t<\/p><p class=\"login-password\">\n\t\t\t\t<label for=\"user_pass\">Password<\/label>\n\t\t\t\t<input type=\"password\" name=\"pwd\" id=\"user_pass\" autocomplete=\"current-password\" spellcheck=\"false\" class=\"input\" value=\"\" size=\"20\" \/>\n\t\t\t<\/p><p class=\"login-remember\"><label><input name=\"rememberme\" type=\"checkbox\" id=\"rememberme\" value=\"forever\" \/> Remember Me<\/label><\/p><p class=\"login-submit\">\n\t\t\t\t<input type=\"submit\" name=\"wp-submit\" id=\"wp-submit\" class=\"button button-primary\" value=\"Log In\" \/>\n\t\t\t\t<input type=\"hidden\" name=\"redirect_to\" value=\"http:\/\/223.30.218.166:8083\/childrenhealth_NPO\/wp-json\/wp\/v2\/pages\/5069\" 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