a:22:{s:4:"uuid";s:36:"a9ecec56-c482-4ee3-875f-795cfd5cc7df";s:8:"langcode";s:2:"en";s:6:"status";s:6:"closed";s:12:"dependencies";a:1:{s:8:"enforced";a:1:{s:6:"module";a:1:{i:0;s:17:"webform_templates";}}}s:5:"_core";a:1:{s:19:"default_config_hash";s:43:"ku1ImOMHUtXxnkectQHhXukgV4yxtV1n83CazBYp_nU";}s:6:"weight";i:0;s:4:"open";N;s:5:"close";N;s:3:"uid";N;s:8:"template";b:1;s:7:"archive";b:0;s:2:"id";s:28:"template_medical_appointment";s:5:"title";s:29:"Request a Medical Appointment";s:11:"description";s:47:"A medical appointment request webform template.";s:8:"category";s:0:"";s:8:"elements";s:5497:"introduction:
  '#markup': 'After you submit the form, a care specialist will call you back within XX hours to schedule an appointment.'
hr:
  '#type': webform_horizontal_rule
call:
  '#markup': 'You may also speak with a care specialist directly by calling <a href="tel:XXX-XXX-XXXX">XXX-XXX-XXXX</a> on Monday–Friday between 8:30 am to 5:00 pm EST.'
general:
  '#type': fieldset
  '#title': 'General Information'
  '#title_display': invisible
  '#attributes':
    style: 'background-color: #efefef'
  type:
    '#type': radios
    '#title': 'Who are you?'
    '#options':
      Patient: Patient
      Caregiver: Caregiver
    '#options_display': buttons
    '#required': true
  relationship:
    '#type': webform_select_other
    '#title': 'What is your relationship to the patient?'
    '#options': relationship
    '#states':
      visible:
        ':input[name="type"]':
          value: Caregiver
      required:
        ':input[name="type"]':
          value: Caregiver
caregiver:
  '#type': fieldset
  '#title': 'Your Information'
  '#states':
    visible:
      ':input[name="type"]':
        value: Caregiver
  caregiver_name:
    '#type': webform_flexbox
    caregiver_first_name:
      '#title': 'Your First Name'
      '#type': textfield
      '#states':
        required:
          ':input[name="type"]':
            value: Caregiver
    caregiver_last_name:
      '#title': 'Your Last Name'
      '#type': textfield
      '#states':
        required:
          ':input[name="type"]':
            value: Caregiver
    '#title': 'Your Name'
  caregiver_contact:
    '#type': webform_flexbox
    caregiver_email:
      '#title': 'Your Email'
      '#type': email
      '#states':
        required:
          ':input[name="type"]':
            value: Caregiver
    caregiver_phone:
      '#title': 'Your Phone'
      '#type': tel
      '#placeholder': 000-000-0000
      '#states':
        required:
          ':input[name="type"]':
            value: Caregiver
  caregiver_phone_preferences:
    '#type': webform_custom_composite
    '#title': 'Your Phone Preferences'
    '#description': |
      Please select the best days and times for us to call you.<br/>
      <em>Leave blank if you have no preferences.</em>
    '#description_display': 'before'
    '#multiple__min_items': '3'
    '#multiple__sorting': false
    '#multiple__operations': false
    '#multiple__add_more': false
    '#element':
      day:
        '#type': select
        '#options':
          Monday: Monday
          Tuesday: Tuesday
          Wednesday: Wednesday
          Thursday: Thursday
          Friday: Fridate
        '#title': 'Day of the Week'
        '#empty_option': 'Any day of the week'
      time:
        '#type': select
        '#options':
          '8am-10am EST': '8am-10am EST'
          '10am-12pm EST': '10am-12pm EST'
          '12pm-2pm EST': '12pm-2pm EST'
          '2pm-4pm EST': '2pm-4pm EST'
        '#title': 'Time of Day'
        '#empty_option': 'Any time of the day'
patient:
  '#type': fieldset
  '#title': 'Patient Information'
  patient_name:
    '#type': webform_flexbox
    patient_first_name:
      '#title': 'Patient First Name'
      '#type': textfield
      '#required': true
    patient_last_name:
      '#title': 'Patient Last Name'
      '#type': textfield
      '#required': true
  patient_contact:
    '#type': webform_flexbox
    patient_email:
      '#title': 'Patient Email'
      '#type': email
      '#states':
        required:
          ':input[name="type"]':
            '!value': Caregiver
    patient_phone:
      '#title': 'Patient Phone'
      '#type': tel
      '#required': true
      '#placeholder': 000-000-0000
      '#states':
        required:
          ':input[name="type"]':
            '!value': Caregiver
  patient_phone_preferences:
    '#type': webform_custom_composite
    '#title': 'Patient Phone Preferences'
    '#description': |
      Please select the best days and times for us to call the patient.<br/>
      <em>Leave blank if the patient has no preferences.</em>'
    '#description_display': 'before'
    '#multiple__min_items': '3'
    '#multiple__sorting': false
    '#multiple__operations': false
    '#multiple__add_more': false
    '#element':
      day:
        '#type': select
        '#options':
          Monday: Monday
          Tuesday: Tuesday
          Wednesday: Wednesday
          Thursday: Thursday
          Friday: Fridate
        '#title': 'Day of the Week'
        '#empty_option': 'Any day of the week'
      time:
        '#type': select
        '#options':
          '8am-10am EST': '8am-10am EST'
          '10am-12pm EST': '10am-12pm EST'
          '12pm-2pm EST': '12pm-2pm EST'
          '2pm-4pm EST': '2pm-4pm EST'
        '#title': 'Time of Day'
        '#empty_option': 'Any time of the day'
appointment:
  '#type': fieldset
  '#title': 'Appointment Information (optional)'
  medical:
    '#type': textarea
    '#title': 'Please provide information about your medical needs'
    '#rows': 3
  insurance:
    '#type': textfield
    '#title': 'Please provide insurance plan name information'''
  referral:
    '#type': checkbox
    '#title': 'Have you been referred by a physician?'
  physician:
    '#type': textarea
    '#title': 'Please provide information about the referring physician'
    '#rows': 3
    '#states':
      visible:
        ':input[name="referral"]':
          checked: true
actions:
  '#type': webform_actions
  '#title': 'Submit button(s)'
  '#submit__label': 'Send Request'
";s:3:"css";s:0:"";s:10:"javascript";s:0:"";s:8:"settings";a:131:{s:4:"ajax";b:0;s:15:"ajax_scroll_top";s:4:"form";s:18:"ajax_progress_type";s:0:"";s:11:"ajax_effect";s:0:"";s:10:"ajax_speed";N;s:4:"page";b:1;s:16:"page_submit_path";s:0:"";s:17:"page_confirm_path";s:0:"";s:15:"page_theme_name";s:0:"";s:10:"form_title";s:21:"source_entity_webform";s:16:"form_submit_once";b:0;s:17:"form_open_message";s:0:"";s:18:"form_close_message";s:0:"";s:22:"form_exception_message";s:0:"";s:25:"form_previous_submissions";b:1;s:17:"form_confidential";b:0;s:25:"form_confidential_message";s:0:"";s:24:"form_disable_remote_addr";b:0;s:22:"form_convert_anonymous";b:0;s:16:"form_prepopulate";b:0;s:30:"form_prepopulate_source_entity";b:0;s:39:"form_prepopulate_source_entity_required";b:0;s:35:"form_prepopulate_source_entity_type";s:0:"";s:12:"form_unsaved";b:1;s:17:"form_disable_back";b:0;s:16:"form_submit_back";b:0;s:25:"form_disable_autocomplete";b:0;s:15:"form_novalidate";b:0;s:26:"form_disable_inline_errors";b:0;s:13:"form_required";b:1;s:14:"form_autofocus";b:0;s:19:"form_details_toggle";b:0;s:10:"form_reset";b:0;s:18:"form_access_denied";s:7:"default";s:24:"form_access_denied_title";s:0:"";s:26:"form_access_denied_message";s:0:"";s:29:"form_access_denied_attributes";a:0:{}s:15:"form_file_limit";s:0:"";s:15:"form_attributes";a:0:{}s:11:"form_method";s:0:"";s:11:"form_action";s:0:"";s:5:"share";b:0;s:10:"share_node";b:0;s:16:"share_theme_name";s:0:"";s:11:"share_title";b:1;s:26:"share_page_body_attributes";a:0:{}s:16:"submission_label";s:0:"";s:28:"submission_exception_message";s:0:"";s:25:"submission_locked_message";s:0:"";s:14:"submission_log";b:0;s:28:"submission_excluded_elements";a:0:{}s:24:"submission_exclude_empty";b:0;s:33:"submission_exclude_empty_checkbox";b:0;s:16:"submission_views";a:0:{}s:24:"submission_views_replace";a:0:{}s:23:"submission_user_columns";a:0:{}s:25:"submission_user_duplicate";b:0;s:24:"submission_access_denied";s:7:"default";s:30:"submission_access_denied_title";s:0:"";s:32:"submission_access_denied_message";s:0:"";s:35:"submission_access_denied_attributes";a:0:{}s:27:"previous_submission_message";s:0:"";s:28:"previous_submissions_message";s:0:"";s:8:"autofill";b:0;s:16:"autofill_message";s:0:"";s:26:"autofill_excluded_elements";a:0:{}s:19:"wizard_progress_bar";b:1;s:21:"wizard_progress_pages";b:0;s:26:"wizard_progress_percentage";b:0;s:20:"wizard_progress_link";b:0;s:22:"wizard_progress_states";b:0;s:18:"wizard_start_label";s:0:"";s:19:"wizard_preview_link";b:0;s:19:"wizard_confirmation";b:1;s:25:"wizard_confirmation_label";s:0:"";s:19:"wizard_auto_forward";b:1;s:36:"wizard_auto_forward_hide_next_button";b:0;s:15:"wizard_keyboard";b:1;s:12:"wizard_track";s:0:"";s:24:"wizard_prev_button_label";s:0:"";s:24:"wizard_next_button_label";s:0:"";s:13:"wizard_toggle";b:0;s:24:"wizard_toggle_show_label";s:0:"";s:24:"wizard_toggle_hide_label";s:0:"";s:7:"preview";i:0;s:13:"preview_label";s:0:"";s:13:"preview_title";s:0:"";s:15:"preview_message";s:0:"";s:18:"preview_attributes";a:0:{}s:25:"preview_excluded_elements";a:0:{}s:21:"preview_exclude_empty";b:1;s:30:"preview_exclude_empty_checkbox";b:0;s:5:"draft";s:4:"none";s:14:"draft_multiple";b:0;s:15:"draft_auto_save";b:0;s:19:"draft_saved_message";s:0:"";s:20:"draft_loaded_message";s:0:"";s:28:"draft_pending_single_message";s:0:"";s:30:"draft_pending_multiple_message";s:0:"";s:17:"confirmation_type";s:4:"page";s:16:"confirmation_url";s:7:"<front>";s:18:"confirmation_title";s:9:"Thank You";s:20:"confirmation_message";s:108:"Your request has been sent. A care specialist will call you back within XX hours to schedule an appointment.";s:23:"confirmation_attributes";a:0:{}s:17:"confirmation_back";b:0;s:23:"confirmation_back_label";s:0:"";s:28:"confirmation_back_attributes";a:0:{}s:26:"confirmation_exclude_query";b:0;s:26:"confirmation_exclude_token";b:0;s:19:"confirmation_update";b:0;s:11:"limit_total";N;s:20:"limit_total_interval";N;s:19:"limit_total_message";s:0:"";s:18:"limit_total_unique";b:0;s:10:"limit_user";N;s:19:"limit_user_interval";N;s:18:"limit_user_message";s:0:"";s:17:"limit_user_unique";b:0;s:18:"entity_limit_total";N;s:27:"entity_limit_total_interval";N;s:17:"entity_limit_user";N;s:26:"entity_limit_user_interval";N;s:5:"purge";s:4:"none";s:10:"purge_days";N;s:16:"results_disabled";b:0;s:23:"results_disabled_ignore";b:0;s:17:"results_customize";b:0;s:10:"token_view";b:0;s:12:"token_update";b:0;s:12:"token_delete";b:0;s:15:"serial_disabled";b:0;}s:6:"access";a:11:{s:6:"create";a:3:{s:5:"roles";a:2:{i:0;s:9:"anonymous";i:1;s:13:"authenticated";}s:5:"users";a:0:{}s:11:"permissions";a:0:{}}s:8:"view_any";a:3:{s:5:"roles";a:0:{}s:5:"users";a:0:{}s:11:"permissions";a:0:{}}s:10:"update_any";a:3:{s:5:"roles";a:0:{}s:5:"users";a:0:{}s:11:"permissions";a:0:{}}s:10:"delete_any";a:3:{s:5:"roles";a:0:{}s:5:"users";a:0:{}s:11:"permissions";a:0:{}}s:9:"purge_any";a:3:{s:5:"roles";a:0:{}s:5:"users";a:0:{}s:11:"permissions";a:0:{}}s:8:"view_own";a:3:{s:5:"roles";a:0:{}s:5:"users";a:0:{}s:11:"permissions";a:0:{}}s:10:"update_own";a:3:{s:5:"roles";a:0:{}s:5:"users";a:0:{}s:11:"permissions";a:0:{}}s:10:"delete_own";a:3:{s:5:"roles";a:0:{}s:5:"users";a:0:{}s:11:"permissions";a:0:{}}s:10:"administer";a:3:{s:5:"roles";a:0:{}s:5:"users";a:0:{}s:11:"permissions";a:0:{}}s:4:"test";a:3:{s:5:"roles";a:0:{}s:5:"users";a:0:{}s:11:"permissions";a:0:{}}s:13:"configuration";a:3:{s:5:"roles";a:0:{}s:5:"users";a:0:{}s:11:"permissions";a:0:{}}}s:8:"handlers";a:1:{s:18:"email_notification";a:8:{s:2:"id";s:5:"email";s:10:"handler_id";s:18:"email_notification";s:5:"label";s:18:"Email notification";s:5:"notes";s:0:"";s:6:"status";b:1;s:10:"conditions";a:0:{}s:6:"weight";i:0;s:8:"settings";a:27:{s:6:"states";a:1:{i:0;s:9:"completed";}s:7:"to_mail";s:8:"_default";s:10:"to_options";a:0:{}s:8:"bcc_mail";s:0:"";s:11:"bcc_options";a:0:{}s:7:"cc_mail";s:0:"";s:10:"cc_options";a:0:{}s:9:"from_mail";s:37:"[webform_submission:values:email:raw]";s:12:"from_options";a:0:{}s:9:"from_name";s:36:"[webform_submission:values:name:raw]";s:8:"reply_to";s:0:"";s:11:"return_path";s:0:"";s:11:"sender_mail";s:0:"";s:11:"sender_name";s:0:"";s:7:"subject";s:39:"[webform_submission:values:subject:raw]";s:4:"body";s:41:"[webform_submission:values:message:value]";s:17:"excluded_elements";a:0:{}s:13:"ignore_access";b:0;s:13:"exclude_empty";b:1;s:22:"exclude_empty_checkbox";b:0;s:19:"exclude_attachments";b:0;s:4:"html";b:1;s:11:"attachments";b:0;s:4:"twig";b:0;s:10:"theme_name";s:0:"";s:10:"parameters";a:0:{}s:5:"debug";b:0;}}}s:8:"variants";a:0:{}}