{"id":1070,"date":"2021-11-17T19:48:46","date_gmt":"2021-11-17T19:48:46","guid":{"rendered":"https:\/\/trinityrehabtherapy.com\/?page_id=1070"},"modified":"2022-01-31T19:48:13","modified_gmt":"2022-01-31T19:48:13","slug":"medwaiver","status":"publish","type":"page","link":"https:\/\/trinityrehabtherapy.com\/es\/medwaiver\/","title":{"rendered":"Medwaiver"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"1070\" class=\"elementor elementor-1070\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-bb4eb1b elementor-section-boxed elementor-section-height-default elementor-section-height-default elementor-invisible\" data-id=\"bb4eb1b\" data-element_type=\"section\" data-settings=\"{&quot;animation&quot;:&quot;fadeIn&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-d3d6f6f\" data-id=\"d3d6f6f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ce0395a elementor-widget elementor-widget-heading\" data-id=\"ce0395a\" data-element_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\">Medwaiver<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5394d7b elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"5394d7b\" data-element_type=\"widget\" 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elementor-mark-required\">\n\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-lg  elementor-field-textual\" placeholder=\"Nombre Completo\" 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_a5609ff elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_a5609ff]\" id=\"form-field-field_a5609ff\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"N\u00famero de Medicaid\" 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_ed13d4b elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ed13d4b]\" id=\"form-field-field_ed13d4b\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Direcci\u00f3n\" 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_a15d6ef elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_a15d6ef]\" id=\"form-field-field_a15d6ef\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Ciudad - C\u00f3digo Postal\" 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_e831730 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_e831730]\" id=\"form-field-field_e831730\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Nombre del Cuidador\" 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-number elementor-field-group elementor-column elementor-field-group-field_5e8bc99 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[field_5e8bc99]\" id=\"form-field-field_5e8bc99\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"N\u00famero de Tel\u00e9fono del Cuidador\" required=\"required\" aria-required=\"true\" min=\"\" max=\"\" >\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_7da8a19 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_7da8a19]\" id=\"form-field-field_7da8a19\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Nombre del Coordinador de Servicio\" 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-number elementor-field-group elementor-column elementor-field-group-field_bbc3a24 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[field_bbc3a24]\" id=\"form-field-field_bbc3a24\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"N\u00famero de Tel\u00e9fono del Coordinador de Servicio\" required=\"required\" aria-required=\"true\" min=\"\" max=\"\" >\n\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_41f140c elementor-col-50 elementor-field-required elementor-mark-required\">\n\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<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_41f140c]\" id=\"form-field-field_41f140c\" class=\"elementor-field-textual elementor-size-lg\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t<option value=\"Preferred Language\">Idioma preferido<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"English\">Ingles<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Spanish\">Espa\u00f1ol<\/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-text elementor-field-group elementor-column elementor-field-group-field_70171e3 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_70171e3]\" id=\"form-field-field_70171e3\" class=\"elementor-field elementor-size-lg  elementor-field-textual\" placeholder=\"Referido por\" 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-html elementor-field-group elementor-column elementor-field-group-field_0012fc9 elementor-col-100\">\n\t\t\t\t\t<h4>Servicios Solicitados<\/h4>\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_aa97c23 elementor-col-33\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Physical Therapy\" id=\"form-field-field_aa97c23-0\" name=\"form_fields[field_aa97c23]\"> <label for=\"form-field-field_aa97c23-0\">Terapia F\u00edsica<\/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_0a7aca6 elementor-col-33\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Occupational Therapy \" id=\"form-field-field_0a7aca6-0\" name=\"form_fields[field_0a7aca6]\"> <label for=\"form-field-field_0a7aca6-0\">Terapia Ocupacional <\/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_b469ec7 elementor-col-33\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Speech Therapy \" id=\"form-field-field_b469ec7-0\" name=\"form_fields[field_b469ec7]\"> <label for=\"form-field-field_b469ec7-0\">Terapia de Lenguaje <\/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\">Enviar<\/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<input type=\"hidden\" name=\"trp-form-language\" value=\"es\"\/><\/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<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Medwaiver<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-1070","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/trinityrehabtherapy.com\/es\/wp-json\/wp\/v2\/pages\/1070","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/trinityrehabtherapy.com\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/trinityrehabtherapy.com\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/trinityrehabtherapy.com\/es\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/trinityrehabtherapy.com\/es\/wp-json\/wp\/v2\/comments?post=1070"}],"version-history":[{"count":0,"href":"https:\/\/trinityrehabtherapy.com\/es\/wp-json\/wp\/v2\/pages\/1070\/revisions"}],"wp:attachment":[{"href":"https:\/\/trinityrehabtherapy.com\/es\/wp-json\/wp\/v2\/media?parent=1070"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}