{"id":2482,"date":"2020-12-19T15:01:01","date_gmt":"2020-12-19T20:01:01","guid":{"rendered":"https:\/\/teleemc.com\/?page_id=2482"},"modified":"2023-02-13T16:20:25","modified_gmt":"2023-02-13T21:20:25","slug":"patient-registration-forms-spanish","status":"publish","type":"page","link":"https:\/\/teleemc.com\/?page_id=2482","title":{"rendered":"Patient Registration Forms &#8211; Spanish"},"content":{"rendered":"[et_pb_section admin_label=&#8221;section&#8221;]\n\t\t\t[et_pb_row admin_label=&#8221;row&#8221;]\n\t\t\t\t[et_pb_column type=&#8221;4_4&#8243;][et_pb_text admin_label=&#8221;Text&#8221;]\n<div id=\"text-form-open\" class=\"text-form-link\" style=\"cursor:pointer;\">\u1405 Send Link in Text<\/div>\n<div id=\"text-form-close\" class=\"text-form-link\" style=\"cursor:pointer;display:none;\">\u25bc Send Link in Text<\/div>\n<div id=\"text-form\" style=\"display:none;\">\n    <input type=\"checkbox\" id=\"text-form-spanish\">&nbsp;Espa\u00f1ol&nbsp;\n    <input type=\"text\" id=\"text-form-phone\" name=\"text-form-phone\" placeholder=\"Area Code and Phone Number\">&nbsp;\n    <button class=\"text-form-link\" id=\"text-form-send\">Send<\/button>\n    <br>\n    <div id=\"text-form-text\"><\/div>\n<\/div>\n\n\n\n<script type=\"text\/javascript\" src=\"https:\/\/hipaa.jotform.com\/jsform\/242164485539161\"><\/script>\n\n\n\n\n<script>\n    var textFormKreyol=\"Mesaj sa a se sou non kiropratisyen ou oswa etablisman MRI ou. TeleEMC ap f\u00e8 yon evalyasyon obligatwa. Tanpri klike sou lyen ki anba a pou w ranpli f\u00f2m yo anvan w konekte ak founis\u00e8 telemedsin nou an. https:\/\/teleemc.com\/patient-registration-forms-creole\/\";\n    var textFormEnglish=\"This text is on behalf of your chiropractor or MRI facility. TeleEMC shall be performing a required evaluation. Please click the link below to complete forms prior to connecting to our telemedicine provider. https:\/\/teleemc.com\/patient-registration-form\/\";\n    var textFormSpanish=\"Este mensaje es en nombre de su quiropr\u00e1ctico o centro de resonancia magn\u00e9tica. TeleEMC realizar\u00e1 una evaluaci\u00f3n requerida. Haga clic en el enlace a continuaci\u00f3n para completar los formularios antes de conectarse con nuestro proveedor de telemedicina. https:\/\/teleemc.com\/patient-registration-forms-spanish\/\";;\n    var spanish=1;\n    var kreyol=0;\n    var text = textFormEnglish;\n\tif (spanish) text = textFormSpanish;\n\tif (kreyol) text = textFormKreyol;\n\n    jQuery('#text-form-open').on('click',function() {jQuery('#text-form-open').hide();jQuery('#text-form-close').show();jQuery('#text-form').show('fast');});\n    jQuery('#text-form-close').on('click',function() {jQuery('#text-form-close').hide();jQuery('#text-form-open').show();jQuery('#text-form').hide('fast');});\n    jQuery(function() {\n\n\tif (spanish == 0) {\n\t\tif (kreyol == 0) {\n\t        \tjQuery('#text-form-text').html(textFormEnglish);\n\t\t} else {\n\t\t\t jQuery('#text-form-text').html(textFormKreyol);\n\t\t\t jQuery('#text-form-kreyol').prop('checked',true);\n\n\t\t}\n\t} else {\n\t        jQuery('#text-form-text').html(textFormSpanish);\n\t\tjQuery('#text-form-spanish').prop('checked',true);\n\t}\n\n        jQuery(\"#text-form-spanish\").change(function() {\n            if(this.checked) {\n                \/\/Do stuff\n                jQuery('#text-form-text').html(textFormSpanish);\n\t\ttext = textFormSpanish;\n\n            } else {\n                jQuery('#text-form-text').html(textFormEnglish);\n\t\ttext = textFormEnglish;\n\n            }\n        });\n        jQuery(\"#text-form-kreyol\").change(function() {\n            if(this.checked) {\n                \/\/Do stuff\n                jQuery('#text-form-text').html(textFormKreyol);\n\t\ttext = textFormKreyol;\n            } else {\n                jQuery('#text-form-text').html(textFormEnglish);\n\t\ttext = textFormEnglish;\n            }\n        });\n        jQuery('#text-form-send').on('click',function() {\n                \/\/ send text\n\n\t\tphone=jQuery('#text-form-phone').val();\n\t\tspanish=jQuery('#text-form-spanish').is(':checked');\n\t\tkreyol=jQuery('#text-form-kreyol').is(':checked');\n\n\t\tif(validatePhone(phone)) {\n\t\t\tif (confirm('Send text to ' + phone + '?')) {\n\n\t\t\t\t $.ajax({\n\t\t\t            url: \"https:\/\/app.teleemc.com\/send-sms-notification\",\n\t\t\t            type: \"POST\",\n\t\t\t            crossDomain: true,\n\t\t\t            data:  { body: 'text-form', kreyol: kreyol, spanish: spanish, phone: phone, text: text },\n\t\t\t            dataType: \"text\",\n\t\t\t            success: function (o) {\n\t\t\t\t\tjQuery('#text-form').html(o);\n\t\t\t            },\n\t\t\t            error: function (xhr, status, x) {\n\t\t\t                alert(\"error\");\n\t\t\t\t\tconsole.log(status);\n\t\t\t\t\tconsole.log(xhr);\n\t\t\t\t\tconsole.log(x);\n\t\t\t            }\n\t\t\t        });\n\n\t\t\t}\n\n\t\t} else {\n\t\t\talert(phone + ' is not a valid phone number');\n\t\t}\n\n\n        });\n\n\n    });\n\nfunction validatePhone(txtPhone) {\n    var filter = \/^((\\+[1-9]{1,4}[ \\-]*)|(\\([0-9]{2,3}\\)[ \\-]*)|([0-9]{2,4})[ \\-]*)*?[0-9]{3,4}?[ \\-]*[0-9]{3,4}?$\/;\n    if (filter.test(txtPhone)) {\n        return true;\n    }\n    else {\n        return false;\n    }\n}\n<\/script>\n\n[\/et_pb_text][\/et_pb_column]\n\t\t\t[\/et_pb_row]\n\t\t[\/et_pb_section]","protected":false},"excerpt":{"rendered":"<p>[et_pb_section admin_label=&#8221;section&#8221;] [et_pb_row admin_label=&#8221;row&#8221;] [et_pb_column type=&#8221;4_4&#8243;][et_pb_text admin_label=&#8221;Text&#8221;] \u1405 Send Link in Text \u25bc Send Link in Text &nbsp;Espa\u00f1ol&nbsp; &nbsp; Send [\/et_pb_text][\/et_pb_column] [\/et_pb_row] [\/et_pb_section]<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"<!-- wp:html -->\n<div id=\"text-form-open\" class=\"text-form-link\" style=\"cursor:pointer;\">\u1405 Send Link in Text<\/div>\n<div id=\"text-form-close\" class=\"text-form-link\" style=\"cursor:pointer;display:none;\">\u25bc Send Link in Text<\/div>\n<div id=\"text-form\" style=\"display:none;\">\n    <input type=\"checkbox\" id=\"text-form-spanish\">&nbsp;Espa\u00f1ol&nbsp;\n    <input type=\"text\" id=\"text-form-phone\" name=\"text-form-phone\" placeholder=\"Area Code and Phone Number\">&nbsp;\n    <button class=\"text-form-link\" id=\"text-form-send\">Send<\/button>\n    <br>\n    <div id=\"text-form-text\"><\/div>\n<\/div>\n<!-- \/wp:html -->\n\n<!-- wp:html -->\n<script type=\"text\/javascript\" src=\"https:\/\/hipaa.jotform.com\/jsform\/200816108546149\"><\/script>\n<!-- \/wp:html -->\n\n<!-- wp:shortcode -->\n[text-form spanish=1]\n<!-- \/wp:shortcode -->","_et_gb_content_width":"","footnotes":""},"class_list":["post-2482","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/teleemc.com\/index.php?rest_route=\/wp\/v2\/pages\/2482","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/teleemc.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/teleemc.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/teleemc.com\/index.php?rest_route=\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/teleemc.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2482"}],"version-history":[{"count":6,"href":"https:\/\/teleemc.com\/index.php?rest_route=\/wp\/v2\/pages\/2482\/revisions"}],"predecessor-version":[{"id":2890,"href":"https:\/\/teleemc.com\/index.php?rest_route=\/wp\/v2\/pages\/2482\/revisions\/2890"}],"wp:attachment":[{"href":"https:\/\/teleemc.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2482"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}