{"id":11042,"date":"2020-12-07T17:18:31","date_gmt":"2020-12-07T22:18:31","guid":{"rendered":"https:\/\/bluesouthcreative.com\/staging\/yiayia-web-app\/?page_id=11042"},"modified":"2020-12-07T17:33:05","modified_gmt":"2020-12-07T22:33:05","slug":"lsq-ellenor-physician-visit-print","status":"publish","type":"page","link":"https:\/\/bluesouthcreative.com\/staging\/yiayia-web-app\/customer\/lsq-ellenor-physician-visit-print\/","title":{"rendered":"LSQ &#8211; Ellenor Physician Visit Print"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 hundred-percent-fullwidth non-hundred-percent-height-scrolling fusion-no-medium-visibility fusion-no-large-visibility\" style=\"background-color: rgba(255,255,255,0);background-position: center center;background-repeat: no-repeat;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;margin-bottom: 10px;margin-top: 15px;border-width: 0px 0px 0px 0px;border-color:#eae9e9;border-style:solid;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last\" style=\"margin-top:0px;margin-bottom:0px;\"><div class=\"fusion-column-wrapper fusion-flex-column-wrapper-legacy\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 0px 0px 0px 30px;\">\n<div>\n<table border=\"0\" cellspacing=\"0px\">\n<tbody>\n<tr>\n<th style=\"text-align: left; padding-left: 0px;\" align=\"center\"><a href=\"https:\/\/bluesouthcreative.com\/staging\/yiayia-web-app\/pl\/pl-dashboard\"><img class=\"aligncenter size-full wp-image-575\" src=\"https:\/\/bluesouthcreative.com\/staging\/yiayia-web-app\/wp-content\/uploads\/2020\/03\/yiayia-mobile-nav-logo.png\" alt=\"\" width=\"26\" height=\"26\" \/><\/a><\/th>\n<th style=\"text-align: left; padding-left: 10px;\" align=\"center\"><a href=\"https:\/\/bluesouthcreative.com\/staging\/yiayia-web-app\/pl\/search-customers\/\"><img class=\"aligncenter size-full wp-image-575\" src=\"https:\/\/bluesouthcreative.com\/staging\/yiayia-web-app\/wp-content\/uploads\/2020\/03\/yiayia-customers-icon-blue.png\" alt=\"\" width=\"26\" height=\"26\" \/><\/a><\/th>\n<th style=\"text-align: left; padding-left: 10px;\" align=\"center\"><a href=\"https:\/\/bluesouthcreative.com\/staging\/yiayia-web-app\/pl\/search-team-members\/\"><img class=\"aligncenter size-full wp-image-575\" src=\"https:\/\/bluesouthcreative.com\/staging\/yiayia-web-app\/wp-content\/uploads\/2020\/03\/yiayia-team-icon-blue.png\" alt=\"\" width=\"26\" height=\"26\" \/><\/a><\/th>\n<th style=\"text-align: left; padding-left: 10px;\" align=\"center\"><a href=\"https:\/\/bluesouthcreative.com\/staging\/yiayia-web-app\/pl\/pl-reporting\/\"><img class=\"aligncenter size-full wp-image-575\" src=\"https:\/\/bluesouthcreative.com\/staging\/yiayia-web-app\/wp-content\/uploads\/2020\/03\/yiayia-reporting-icon-blue.png\" alt=\"\" width=\"26\" height=\"26\" \/><\/a><\/th>\n<th style=\"text-align: left; padding-left: 10px;\" align=\"center\"><a href=\"https:\/\/bluesouthcreative.com\/staging\/yiayia-web-app\/pl\/my-account\/\"><img class=\"aligncenter size-full wp-image-575\" src=\"https:\/\/bluesouthcreative.com\/staging\/yiayia-web-app\/wp-content\/uploads\/2019\/10\/robert-brown-icon.png\" alt=\"\" width=\"26\" height=\"26\" \/><\/a><\/th>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<div class=\"fusion-clearfix\"><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last\" style=\"margin-top:0px;margin-bottom:0px;\"><div class=\"fusion-column-wrapper fusion-flex-column-wrapper-legacy\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 0px 0px 0px 0px;\"><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"margin-left: auto;margin-right: auto;margin-top:15px;width:100%;\"><div class=\"fusion-separator-border sep-single sep-solid\" style=\"border-color:#d3d3d3;border-top-width:1px;\"><\/div><\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><\/div>\n<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 hundred-percent-fullwidth non-hundred-percent-height-scrolling fusion-equal-height-columns\" style=\"background-color: rgba(255,255,255,0);background-position: center center;background-repeat: no-repeat;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;margin-bottom: 0px;margin-top: 0px;border-width: 0px 0px 0px 0px;border-color:#eae9e9;border-style:solid;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last\" style=\"margin-top:0px;margin-bottom:0px;\"><div class=\"fusion-column-wrapper fusion-flex-column-wrapper-legacy\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 0px 30px 0px 30px;\"><div class=\"fusion-builder-row fusion-builder-row-inner fusion-row\"><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-0 fusion_builder_column_inner_5_6 5_6 fusion-five-sixth fusion-column-first fusion-column-no-min-height fusion-no-small-visibility\" style=\"width:83.333333333333%;width:calc(83.333333333333% - ( ( 0px ) * 0.83333333333333 ) );margin-right: 0px;margin-top:20px;margin-bottom:0px;\"><div class=\"fusion-column-wrapper fusion-flex-column-wrapper-legacy\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 0px 0px 0px 0px;\"><div class=\"fusion-text fusion-text-1\"><div>\n<table border=\"0\" cellspacing=\"0px\">\n<tbody>\n<tr>\n<th style=\"text-align: left; padding-left: 0px; padding-right: 15px; padding-top: 12px; vertical-align: top;\" align=\"top\"><img class=\"aligncenter size-full wp-image-5566\" src=\"https:\/\/bluesouthcreative.com\/staging\/yiayia-web-app\/wp-content\/uploads\/2020\/04\/ellenor-johnson-circle-white-36.png\" alt=\"\" width=\"36\" height=\"36\" \/><\/th>\n<th align=\"left\">\n<h1 style=\"margin-bottom: 0px; margin-top: 8px; margin-left: 0px; table-layout: auto;\"><a title=\"\" href=\"https:\/\/bluesouthcreative.com\/staging\/yiayia-web-app\/customer\/ellenor-health\/\">Ellenor Johnson<\/a><\/h1>\n<p class=\"new-view\">Unit 117 \u00a0 | \u00a0 Assisted Living<\/p>\n<\/th>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-1 fusion_builder_column_inner_1_6 1_6 fusion-one-sixth fusion-column-last fusion-column-no-min-height\" style=\"width:16.666666666667%;width:calc(16.666666666667% - ( ( 0px ) * 0.16666666666667 ) );margin-top:0px;margin-bottom:0px;\"><div class=\"fusion-column-wrapper fusion-flex-column-wrapper-legacy\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 0px 0px 0px 0px;\"><span class=\" fusion-imageframe imageframe-none imageframe-1 hover-type-none\" style=\"margin-left:25px;float:right;margin-right:0px;\"><img width=\"216\" height=\"216\" src=\"https:\/\/bluesouthcreative.com\/staging\/yiayia-web-app\/wp-content\/uploads\/2019\/10\/legacy-website-logo.jpg\" class=\"img-responsive wp-image-1018\" srcset=\"https:\/\/bluesouthcreative.com\/staging\/yiayia-web-app\/wp-content\/uploads\/2019\/10\/legacy-website-logo-200x200.jpg 200w, https:\/\/bluesouthcreative.com\/staging\/yiayia-web-app\/wp-content\/uploads\/2019\/10\/legacy-website-logo.jpg 216w\" sizes=\"(max-width: 800px) 100vw, 200px\" \/><\/span><div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"margin-left: auto;margin-right: auto;margin-top:30px;width:100%;\"><\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-text fusion-text-2\"><div style=\"margin-bottom: 15px; border-bottom: 1px solid #bbbbbb;\">\n<table border=\"0\" width=\"100%\" cellspacing=\"0px\">\n<tbody>\n<tr>\n<th style=\"text-align: left; padding-left: 0px;\" align=\"left\" width=\"20%\">\n<h3 style=\"padding: 15px 0 6px 0; margin: 0 0 3px 0; font-size: 18px; line-height: 1; font-family: Roboto Slab,Tahoma,sans-serif; font-weight: 300; color: #005174; background-color: transparent;\">Physician Visit<\/h3>\n<\/th>\n<th style=\"text-align: left; padding-left: 0px; margin-top: 20px; margin-bottom: 0px;\" align=\"right\" width=\"41%\"><\/th>\n<th style=\"text-align: left; padding-left: 0px; margin-top: 20px; margin-bottom: 0px;\" align=\"right\" width=\"30%\"><span style=\"margin-top: 10px; text-align: right;\">Physician Visit | 12\/02\/2020<\/span><\/th>\n<th style=\"text-align: right; padding-left: 0px;\" align=\"right\" width=\"3%\"><a title=\"Print\" href=\"#\" target=\"_self\" rel=\"noopener noreferrer\"><div class=\"fusion-fa-align-right\"><i class=\"fb-icon-element-1 fb-icon-element fontawesome-icon fa-print fas circle-no\" style=\"font-size:18px;margin-top:4px;margin-right:5px;margin-bottom:0px;\"><\/i><\/div><style>i.fb-icon-element.fontawesome-icon.fb-icon-element-1{ color: #005174;}i.fb-icon-element.fontawesome-icon.fb-icon-element-1:hover { color: #005174;}<\/style><\/a><\/th>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div><div class=\"fusion-text fusion-text-3\"><div class=\"frm_forms  with_frm_style frm_style_minimal-info-style\" id=\"frm_form_366_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_physicians-visit-print\"  >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Physician's Visit Print<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"366\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_366\" id=\"frm_hide_fields_366\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"physicians-visit-print\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_366\" name=\"frm_submit_entry_366\" value=\"cf8567ed34\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/staging\/yiayia-web-app\/wp-json\/wp\/v2\/pages\/11042\" \/><input type=\"hidden\" name=\"item_meta[11123]\" id=\"field_72bn6e3973806af4c688d16cdd321f73da3\" value=\"\"  data-invmsg=\"Comp Needs Hidden is invalid\"   \/>\n<div id=\"frm_field_11124_container\" class=\"frm_form_field frm_section_heading form-field  frm_hide_section\">\r\n<h3 class=\"frm_pos_none frm_section_spacing\">Physician Visit<\/h3>\r\n\r\n\r\n<div id=\"frm_field_11125_container\" class=\"frm_form_field form-field  frm_top_container frm_sixth frm_first\">\r\n    <label for=\"field_bl1ry04587b9de3dffb02ec2f0027d95929\" id=\"field_bl1ry04587b9de3dffb02ec2f0027d95929_label\" class=\"frm_primary_label\">Physician Details\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_bl1ry04587b9de3dffb02ec2f0027d95929\" name=\"item_meta[11125]\" value=\"Dr. Milo Silver\"  data-sectionid=\"11124\" data-frmval=\"Dr. Milo Silver\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_11126_container\" class=\"frm_form_field form-field  frm_top_container frm_sixth\">\r\n    <label for=\"field_xdcpm8d6482217f\" id=\"field_xdcpm8d6482217f_label\" class=\"frm_primary_label\">Physician Phone\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_xdcpm8d6482217f\" name=\"item_meta[11126]\" value=\"808.555.2345\"  data-sectionid=\"11124\" data-frmval=\"808.555.2345\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_11127_container\" class=\"frm_form_field form-field  frm_top_container frm_sixth\">\r\n    <label for=\"field_scb20b45c4f64d2\" id=\"field_scb20b45c4f64d2_label\" class=\"frm_primary_label\">Change in Medications\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_scb20b45c4f64d2\" name=\"item_meta[11127]\" value=\"Yes\"  data-sectionid=\"11124\" data-frmval=\"Yes\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_11128_container\" class=\"frm_form_field form-field  frm_top_container frm_sixth\">\r\n    <label for=\"field_imauv98f426a54f\" id=\"field_imauv98f426a54f_label\" class=\"frm_primary_label\">New Rx Provided\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_imauv98f426a54f\" name=\"item_meta[11128]\" value=\"Yes\"  data-sectionid=\"11124\" data-frmval=\"Yes\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_11129_container\" class=\"frm_form_field form-field  frm_top_container frm_sixth\">\r\n    <label for=\"field_o9cm4a3e9004dc0\" id=\"field_o9cm4a3e9004dc0_label\" class=\"frm_primary_label\">Next Appointment Date\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_o9cm4a3e9004dc0\" name=\"item_meta[11129]\" value=\"11\/05\/20\"  data-sectionid=\"11124\" data-frmval=\"11\/05\/20\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_11130_container\" class=\"frm_form_field form-field  frm_top_container frm_sixth\">\r\n    <label for=\"field_i5vdpb16ea58207\" id=\"field_i5vdpb16ea58207_label\" class=\"frm_primary_label\">Next Appointment Time\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_i5vdpb16ea58207\" name=\"item_meta[11130]\" value=\"10:00 am\"  data-sectionid=\"11124\" data-frmval=\"10:00 am\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_11131_container\" class=\"frm_form_field form-field  frm_top_container frm_sixth frm_first\">\r\n    <label for=\"field_hdf1f60a91cae1a\" id=\"field_hdf1f60a91cae1a_label\" class=\"frm_primary_label\">Weight\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_hdf1f60a91cae1a\" name=\"item_meta[11131]\" value=\"136 lbs.\"  data-sectionid=\"11124\" data-frmval=\"136 lbs.\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_11132_container\" class=\"frm_form_field form-field  frm_top_container frm_sixth\">\r\n    <label for=\"field_zgqrd92479c7c6e\" id=\"field_zgqrd92479c7c6e_label\" class=\"frm_primary_label\">Temperature\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_zgqrd92479c7c6e\" name=\"item_meta[11132]\" value=\"99.0 F\"  data-sectionid=\"11124\" data-frmval=\"99.0 F\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_11133_container\" class=\"frm_form_field form-field  frm_top_container frm_sixth\">\r\n    <label for=\"field_knp01114c49f1c6\" id=\"field_knp01114c49f1c6_label\" class=\"frm_primary_label\">Pulse\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_knp01114c49f1c6\" name=\"item_meta[11133]\" value=\"65 bpm\"  data-sectionid=\"11124\" data-frmval=\"65 bpm\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_11134_container\" class=\"frm_form_field form-field  frm_top_container frm_sixth\">\r\n    <label for=\"field_nn33f660fd63fb4\" id=\"field_nn33f660fd63fb4_label\" class=\"frm_primary_label\">Respiratory\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_nn33f660fd63fb4\" name=\"item_meta[11134]\" value=\"35 bpm\"  data-sectionid=\"11124\" data-frmval=\"35 bpm\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_11135_container\" class=\"frm_form_field form-field  frm_top_container frm_sixth\">\r\n    <label for=\"field_mwxm\" id=\"field_mwxm_label\" class=\"frm_primary_label\">Blood Pressure\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_mwxm\" name=\"item_meta[11135]\" value=\"120 \/ 75\"  data-sectionid=\"11124\" data-frmval=\"120 \/ 75\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_11136_container\" class=\"frm_form_field form-field  frm_top_container frm_half frm_first\">\r\n    <label for=\"field_suxebed89bb7983537a54bbb461a9999e36\" id=\"field_suxebed89bb7983537a54bbb461a9999e36_label\" class=\"frm_primary_label\">Findings and Recommendations\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[11136]\" id=\"field_suxebed89bb7983537a54bbb461a9999e36\" rows=\"3\"  data-sectionid=\"11124\" data-frmval=\"Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. \" data-invmsg=\"Findings and Recommendations is invalid\" aria-invalid=\"false\"  >Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. <\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_11137_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_kctdxda9756fd1c\" id=\"field_kctdxda9756fd1c_label\" class=\"frm_primary_label\">Current Findings\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[11137]\" id=\"field_kctdxda9756fd1c\" rows=\"3\"  data-sectionid=\"11124\" data-frmval=\"Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. \" data-invmsg=\"Current Findings is invalid\" aria-invalid=\"false\"  >Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. <\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_11138_container\" class=\"frm_form_field form-field  frm_top_container frm_half frm_first\">\r\n    <label for=\"field_o2hlh47ab434afe\" id=\"field_o2hlh47ab434afe_label\" class=\"frm_primary_label\">Comments\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[11138]\" id=\"field_o2hlh47ab434afe\" rows=\"3\"  data-sectionid=\"11124\" data-frmval=\"Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. \" data-invmsg=\"Comments is invalid\" aria-invalid=\"false\"  >Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. <\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_11139_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_czltbb486f0eae5\" id=\"field_czltbb486f0eae5_label\" class=\"frm_primary_label\">Suggested Follow-up\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[11139]\" id=\"field_czltbb486f0eae5\" rows=\"3\"  data-sectionid=\"11124\" data-frmval=\"Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. \" data-invmsg=\"Suggested Follow-up is invalid\" aria-invalid=\"false\"  >Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. <\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_11140_container\" class=\"frm_form_field form-field  frm_top_container frm_half frm_first\">\r\n    <label for=\"field_1oi0o705ad77c5b\" id=\"field_1oi0o705ad77c5b_label\" class=\"frm_primary_label\">Signature\r\n        <span class=\"frm_required\"><\/span>\r\n    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