{"id":3918,"date":"2019-09-20T13:17:47","date_gmt":"2019-09-20T13:17:47","guid":{"rendered":"https:\/\/www.christusems.org\/?page_id=3918"},"modified":"2021-03-25T15:33:46","modified_gmt":"2021-03-25T15:33:46","slug":"patient-family-member-emergency","status":"publish","type":"page","link":"https:\/\/www.christusems.org\/?page_id=3918","title":{"rendered":"Patient\/Family Member -Emergency"},"content":{"rendered":"<div id=\"pl-3918\"  class=\"panel-layout\" ><div id=\"pg-3918-0\"  class=\"panel-grid panel-no-style\" ><div id=\"pgc-3918-0-0\"  class=\"panel-grid-cell\" ><div id=\"panel-3918-0-0-0\" class=\"so-panel widget widget_sow-image panel-first-child\" data-index=\"0\" ><div\n\t\t\t\n\t\t\tclass=\"so-widget-sow-image so-widget-sow-image-default-c67d20f9f743-3918\"\n\t\t\t\n\t\t>\n\n<div class=\"sow-image-container\">\n\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.christusems.org\/wp-content\/uploads\/2019\/11\/collage-2.jpg\" width=\"12000\" height=\"4000\" srcset=\"https:\/\/www.christusems.org\/wp-content\/uploads\/2019\/11\/collage-2.jpg 12000w, https:\/\/www.christusems.org\/wp-content\/uploads\/2019\/11\/collage-2-300x100.jpg 300w, https:\/\/www.christusems.org\/wp-content\/uploads\/2019\/11\/collage-2-768x256.jpg 768w, https:\/\/www.christusems.org\/wp-content\/uploads\/2019\/11\/collage-2-1024x341.jpg 1024w\" sizes=\"auto, (max-width: 12000px) 100vw, 12000px\" title=\"collage 2\" alt=\"\" \t\tclass=\"so-widget-image\"\/>\n\t<\/div>\n\n<\/div><\/div><div id=\"panel-3918-0-0-1\" class=\"so-panel widget widget_sow-editor panel-last-child\" data-index=\"1\" ><div\n\t\t\t\n\t\t\tclass=\"so-widget-sow-editor so-widget-sow-editor-base\"\n\t\t\t\n\t\t>\n<div class=\"siteorigin-widget-tinymce textwidget\">\n\t<h2 style=\"text-align: center;\"><strong>Patient\/Family Member -Emergency Survey<\/strong><\/h2>\n<\/div>\n<\/div><\/div><\/div><\/div><div id=\"pg-3918-1\"  class=\"panel-grid panel-no-style\" ><div id=\"pgc-3918-1-0\"  class=\"panel-grid-cell\" ><div id=\"panel-3918-1-0-0\" class=\"so-panel widget widget_text panel-first-child panel-last-child\" data-index=\"2\" >\t\t\t<div class=\"textwidget\"><style type=\"text\/css\">#ipt_fsqm_form_wrap_56 .ipt_fsqm_form_logo img,\n\t#ipt_fsqm_form_wrap_56 .ipt-eform-width-restrain,\n\t#ipt_fsqm_form_wrap_56 .ipt_fsqm_form_message_restore,\n\t#ipt_fsqm_form_wrap_56 .ipt_fsqm_form_message_success,\n\t#ipt_fsqm_form_wrap_56 .ipt_fsqm_form_message_error,\n\t#ipt_fsqm_form_wrap_56 .ipt_fsqm_form_message_process,\n\t#ipt_fsqm_form_wrap_56 .ipt_fsqm_form_validation_error,\n\t#ipt_fsqm_form_wrap_56 .eform-ui-estimator {\n\t\tmax-width: 100%;\n\t\tmin-width: 240px;\n\t}\n\n\t\/**\/<\/style><div\nid=\"ipt_fsqm_form_wrap_56\"\nclass=\"ipt_uif_front ipt_uif_common ipt_fsqm_form type_2 ui-front eform-ltr eform-override-element-boxy eform-override-alignment-inherit\"\ndata-fsqmsayt=\"{&quot;auto_save&quot;:false,&quot;show_restore&quot;:true,&quot;restore&quot;:false,&quot;admin_override&quot;:false,&quot;user_update&quot;:false,&quot;interval_save&quot;:false,&quot;interval&quot;:&quot;30&quot;}\"\ndata-ui-type=\"2\"\ndata-ui-theme=\"[&quot;https:\\\/\\\/www.christusems.org\\\/wp-content\\\/plugins\\\/wp-fsqm-pro\\\/static\\\/front\\\/css\\\/material-themes\\\/light-themes\\\/teal.css?ver=4.18.0&quot;]\"\ndata-ui-theme-id=\"material-default\"\ndata-eformanim=\"0\"\ndata-fsqmga=\"{&quot;enabled&quot;:false,&quot;manual_load&quot;:false,&quot;tracking_id&quot;:&quot;&quot;,&quot;cookie&quot;:&quot;auto&quot;,&quot;user_update&quot;:false,&quot;name&quot;:&quot;Patient\\\/Family Member -Emergency Survey&quot;,&quot;form_id&quot;:&quot;56&quot;}\"\ndata-fsqmreset=\"{&quot;reset&quot;:false,&quot;delay&quot;:10}\"\ndata-eformreg=\"{&quot;enabled&quot;:false,&quot;username_id&quot;:&quot;ipt_fsqm_form_56_pinfo_&quot;,&quot;password_id&quot;:&quot;ipt_fsqm_form_56_pinfo_&quot;,&quot;hide_pinfo&quot;:false,&quot;hide_meta&quot;:false,&quot;meta&quot;:[]}\"\ndata-eformscroll=\"{&quot;progress&quot;:true,&quot;message&quot;:true,&quot;offset&quot;:&quot;0&quot;,&quot;scrollOnError&quot;:true}\"\ndata-eform-cookie=\"0\"\ndata-subscription-form=\"false\"\ndata-instant-subscription=\"{&quot;doable&quot;:true,&quot;config&quot;:{&quot;enabled&quot;:false,&quot;min_tab&quot;:&quot;&quot;,&quot;debounce&quot;:&quot;3000&quot;},&quot;nonce&quot;:&quot;a5f297b3dc&quot;}\"\n>\n<noscript><div\nclass=\"ipt_fsqm_form_message_noscript ui-widget ui-widget-content ui-corner-all\"><div\nclass=\"ui-helper-reset ui-helper-clearfix ui-widget-header ui-corner-all\"><div>Javascript is disabled<\/div><\/div><div\nclass=\"ui-widget-content ui-corner-bottom\"><p>Javascript is disabled on your browser. 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id=\"ipt_fsqm_form_56_progressbar\"><div\nclass=\"ipt_uif_progress_value\"><span\nclass=\"eform-progress-value-span\"><\/span><\/div><\/div><div\ndata-settings=\"{&quot;can_previous&quot;:true,&quot;show_progress_bar&quot;:true,&quot;progress_bar_bottom&quot;:false,&quot;block_previous&quot;:false,&quot;any_tab&quot;:false,&quot;type&quot;:&quot;2&quot;,&quot;scroll&quot;:true,&quot;decimal_point&quot;:2,&quot;auto_progress&quot;:false,&quot;auto_progress_delay&quot;:&quot;1500&quot;,&quot;auto_submit&quot;:false,&quot;hidden_buttons&quot;:false,&quot;scroll_on_error&quot;:true}\" class=\"ipt_fsqm_main_tab ipt_uif_tabs horizontal\"><div\nclass=\"ipt-eform-tab-nav-wrap\"><ul><li\nid=\"ipt_fsqm_form_56_tab_0_control_li\"><a\nclass=\"eform-ripple\" href=\"#ipt_fsqm_form_56_tab_0\"><span\nclass=\"eform-tab-labels\">Patient\/Family Member -Emergency Survey <\/span><\/a><\/li><\/ul>\n<i\nclass=\"eform-tab-nav eform-tab-nav-right ipt-icomoon-angle-right disabled eform-ripple\"><\/i>\n<i\nclass=\"eform-tab-nav eform-tab-nav-left ipt-icomoon-angle-left disabled eform-ripple\"><\/i>\n<span\nclass=\"eform-tab-passive-notifier\"><\/span>\n<span\nclass=\"eform-tab-active-notifier\"><\/span><\/div><div\nid=\"ipt_fsqm_form_56_tab_0\" class=\"ipt_fsqm_form_tab_panel\"><div\nid=\"ipt_fsqm_form_56_layout_0_inner\" class=\"ipt-eform-layout-wrapper\"><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_main_heading_column\"><div\nclass=\"ipt_uif_column_inner\"><h3 class=\"ipt_fsqm_main_heading ipt_uif_heading ipt_uif_divider ipt_uif_align_left ipt_uif_divider_no_icon ipt_uif_divider_icon_no_bg\">\n<span\nclass=\"ipt_uif_divider_text\">\n<span\nclass=\"ipt_uif_divider_text_inner\">\nPatient\/Family Member -Emergency Survey<span\nclass=\"subtitle\"><\/span>\t\t\t\t<\/span>\n<\/span><\/h3><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[design][0][m_type]\" id=\"ipt_fsqm_form_56_design_0_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[design][0][type]\" id=\"ipt_fsqm_form_56_design_0_type\" value=\"richtext\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional\" id=\"ipt_fsqm_form_56_design_0\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_richtext\"><p\nstyle=\"color: #888888; float: left; width: 1503px; margin-top: 0px; margin-bottom: 10px; font-family: Arial, Helvetica, sans-serif;\">Dear Patient or Family Member:<\/p><p\nstyle=\"color: #888888; float: left; width: 1503px; margin-top: 10px; margin-bottom: 10px; font-family: Arial, Helvetica, sans-serif;\">Recently, CHRISTUS EMS treated and transported you or a member of your family as the result of an emergency. We hope you or your family member is recovering from the illness or injury. The staff at CHRISTUS EMS is committed to providing excellent patient care to all of our patients. Please take a moment of your time to answer these questions, your feedback will assist us in continuously improving the quality of care and services we provide.<\/p><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[pinfo][0][m_type]\" id=\"ipt_fsqm_form_56_pinfo_0_m_type\" value=\"pinfo\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[pinfo][0][type]\" id=\"ipt_fsqm_form_56_pinfo_0_type\" value=\"f_name\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_f_name\" id=\"ipt_fsqm_form_56_pinfo_0\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_full\"><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field has-icon\">\n<input\nclass=\" check_me validate[custom[personName]] 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data-sayt-exclude name=\"ipt_fsqm_form_56[pinfo][3][type]\" id=\"ipt_fsqm_form_56_pinfo_3_type\" value=\"phone\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_phone\" id=\"ipt_fsqm_form_56_pinfo_3\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_full\"><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field has-icon\">\n<input\nclass=\" check_me validate[custom[phone]] ipt_uif_text\"\ntype=\"tel\"\nname=\"ipt_fsqm_form_56[pinfo][3][value]\"\nid=\"ipt_fsqm_form_56_pinfo_3_value\"\nmaxlength=\"\"\t\tvalue=\"\" \/>\n<i\ntitle=\"\" class=\" ipticm prefix\" data-ipt-icomoon=\"&#xe08c;\"><\/i>\n<label\nfor=\"ipt_fsqm_form_56_pinfo_3_value\">Phone (Leave blank if you wish to remain anonymous)<\/label><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[mcq][0][m_type]\" id=\"ipt_fsqm_form_56_mcq_0_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[mcq][0][type]\" id=\"ipt_fsqm_form_56_mcq_0_type\" value=\"radio\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_radio\" id=\"ipt_fsqm_form_56_mcq_0\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_56_mcq_0\">When you called for service, the Dispatcher on the phone was courteous and helpful.<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_1\">\n<input\nchecked=\"checked\"\t\t data-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][0][options][]\"\nid=\"ipt_fsqm_form_56_mcq_0_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_0_options__0\" data-labelcon=\"&#xe18e;\">\nAgree\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][0][options][]\"\nid=\"ipt_fsqm_form_56_mcq_0_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_0_options__1\" data-labelcon=\"&#xe18e;\">\nNeutral\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][0][options][]\"\nid=\"ipt_fsqm_form_56_mcq_0_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_0_options__2\" data-labelcon=\"&#xe18e;\">\nDisagree\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][0][options][]\"\nid=\"ipt_fsqm_form_56_mcq_0_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_0_options__3\" data-labelcon=\"&#xe18e;\">\nDon't Know\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[mcq][17][m_type]\" id=\"ipt_fsqm_form_56_mcq_17_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[mcq][17][type]\" id=\"ipt_fsqm_form_56_mcq_17_type\" value=\"radio\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_radio\" id=\"ipt_fsqm_form_56_mcq_17\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_56_mcq_17\">CHRISTUS EMS arrived quickly to your emergency.<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_1\">\n<input\nchecked=\"checked\"\t\t data-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][17][options][]\"\nid=\"ipt_fsqm_form_56_mcq_17_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_17_options__0\" data-labelcon=\"&#xe18e;\">\nAgree\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][17][options][]\"\nid=\"ipt_fsqm_form_56_mcq_17_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_17_options__1\" data-labelcon=\"&#xe18e;\">\nNeutral\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][17][options][]\"\nid=\"ipt_fsqm_form_56_mcq_17_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_17_options__2\" data-labelcon=\"&#xe18e;\">\nDisagree\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][17][options][]\"\nid=\"ipt_fsqm_form_56_mcq_17_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_17_options__3\" data-labelcon=\"&#xe18e;\">\nDon't Know\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[mcq][16][m_type]\" id=\"ipt_fsqm_form_56_mcq_16_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[mcq][16][type]\" id=\"ipt_fsqm_form_56_mcq_16_type\" value=\"radio\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_radio\" id=\"ipt_fsqm_form_56_mcq_16\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_56_mcq_16\">The CHRISTUS EMS personnel acted in a compassionate and caring manner.<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_1\">\n<input\nchecked=\"checked\"\t\t data-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][16][options][]\"\nid=\"ipt_fsqm_form_56_mcq_16_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_16_options__0\" data-labelcon=\"&#xe18e;\">\nAgree\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][16][options][]\"\nid=\"ipt_fsqm_form_56_mcq_16_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_16_options__1\" data-labelcon=\"&#xe18e;\">\nNeutral\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][16][options][]\"\nid=\"ipt_fsqm_form_56_mcq_16_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_16_options__2\" data-labelcon=\"&#xe18e;\">\nDisagree\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][16][options][]\"\nid=\"ipt_fsqm_form_56_mcq_16_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_16_options__3\" data-labelcon=\"&#xe18e;\">\nDon't Know\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[mcq][15][m_type]\" id=\"ipt_fsqm_form_56_mcq_15_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[mcq][15][type]\" id=\"ipt_fsqm_form_56_mcq_15_type\" value=\"radio\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_radio\" id=\"ipt_fsqm_form_56_mcq_15\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_56_mcq_15\">The CHRISTUS EMS personnel were knowledgeable and competent.<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_1\">\n<input\nchecked=\"checked\"\t\t data-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][15][options][]\"\nid=\"ipt_fsqm_form_56_mcq_15_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_15_options__0\" data-labelcon=\"&#xe18e;\">\nAgree\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][15][options][]\"\nid=\"ipt_fsqm_form_56_mcq_15_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_15_options__1\" data-labelcon=\"&#xe18e;\">\nNeutral\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][15][options][]\"\nid=\"ipt_fsqm_form_56_mcq_15_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_15_options__2\" data-labelcon=\"&#xe18e;\">\nDisagree\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][15][options][]\"\nid=\"ipt_fsqm_form_56_mcq_15_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_15_options__3\" data-labelcon=\"&#xe18e;\">\nDon't Know\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[mcq][14][m_type]\" id=\"ipt_fsqm_form_56_mcq_14_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[mcq][14][type]\" id=\"ipt_fsqm_form_56_mcq_14_type\" value=\"radio\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_radio\" id=\"ipt_fsqm_form_56_mcq_14\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_56_mcq_14\">The CHRISTUS EMS personnel told me or a family member what they were doing and listened to me.<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_1\">\n<input\nchecked=\"checked\"\t\t data-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][14][options][]\"\nid=\"ipt_fsqm_form_56_mcq_14_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_14_options__0\" data-labelcon=\"&#xe18e;\">\nAgree\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][14][options][]\"\nid=\"ipt_fsqm_form_56_mcq_14_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_14_options__1\" data-labelcon=\"&#xe18e;\">\nNeutral\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][14][options][]\"\nid=\"ipt_fsqm_form_56_mcq_14_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_14_options__2\" data-labelcon=\"&#xe18e;\">\nDisagree\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][14][options][]\"\nid=\"ipt_fsqm_form_56_mcq_14_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_14_options__3\" data-labelcon=\"&#xe18e;\">\nDon't Know\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[mcq][13][m_type]\" id=\"ipt_fsqm_form_56_mcq_13_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[mcq][13][type]\" id=\"ipt_fsqm_form_56_mcq_13_type\" value=\"radio\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_radio\" id=\"ipt_fsqm_form_56_mcq_13\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_56_mcq_13\">The CHRISTUS EMS personnel were polite and respectful.<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_1\">\n<input\nchecked=\"checked\"\t\t data-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][13][options][]\"\nid=\"ipt_fsqm_form_56_mcq_13_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_13_options__0\" data-labelcon=\"&#xe18e;\">\nAgree\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][13][options][]\"\nid=\"ipt_fsqm_form_56_mcq_13_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_13_options__1\" data-labelcon=\"&#xe18e;\">\nNeutral\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][13][options][]\"\nid=\"ipt_fsqm_form_56_mcq_13_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_13_options__2\" data-labelcon=\"&#xe18e;\">\nDisagree\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][13][options][]\"\nid=\"ipt_fsqm_form_56_mcq_13_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_13_options__3\" data-labelcon=\"&#xe18e;\">\nDon't Know\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[mcq][12][m_type]\" id=\"ipt_fsqm_form_56_mcq_12_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[mcq][12][type]\" id=\"ipt_fsqm_form_56_mcq_12_type\" value=\"radio\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_radio\" id=\"ipt_fsqm_form_56_mcq_12\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_56_mcq_12\">The CHRISTUS EMS personnel were professional in conduct and appearance.<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_1\">\n<input\nchecked=\"checked\"\t\t data-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][12][options][]\"\nid=\"ipt_fsqm_form_56_mcq_12_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_12_options__0\" data-labelcon=\"&#xe18e;\">\nAgree\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][12][options][]\"\nid=\"ipt_fsqm_form_56_mcq_12_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_12_options__1\" data-labelcon=\"&#xe18e;\">\nNeutral\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][12][options][]\"\nid=\"ipt_fsqm_form_56_mcq_12_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_12_options__2\" data-labelcon=\"&#xe18e;\">\nDisagree\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][12][options][]\"\nid=\"ipt_fsqm_form_56_mcq_12_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_12_options__3\" data-labelcon=\"&#xe18e;\">\nDon't Know\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[mcq][11][m_type]\" id=\"ipt_fsqm_form_56_mcq_11_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[mcq][11][type]\" id=\"ipt_fsqm_form_56_mcq_11_type\" value=\"radio\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_radio\" id=\"ipt_fsqm_form_56_mcq_11\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_56_mcq_11\">The overall quality of care i received from CHRISTUS EMS was excellent.<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_1\">\n<input\nchecked=\"checked\"\t\t data-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][11][options][]\"\nid=\"ipt_fsqm_form_56_mcq_11_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_11_options__0\" data-labelcon=\"&#xe18e;\">\nAgree\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][11][options][]\"\nid=\"ipt_fsqm_form_56_mcq_11_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_11_options__1\" data-labelcon=\"&#xe18e;\">\nNeutral\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][11][options][]\"\nid=\"ipt_fsqm_form_56_mcq_11_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_11_options__2\" data-labelcon=\"&#xe18e;\">\nDisagree\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][11][options][]\"\nid=\"ipt_fsqm_form_56_mcq_11_options__3\"\nvalue=\"3\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_11_options__3\" data-labelcon=\"&#xe18e;\">\nDon't Know\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[mcq][10][m_type]\" id=\"ipt_fsqm_form_56_mcq_10_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[mcq][10][type]\" id=\"ipt_fsqm_form_56_mcq_10_type\" value=\"radio\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_radio\" id=\"ipt_fsqm_form_56_mcq_10\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_56_mcq_10\">The Overall actions of CHRISTUS EMS personnel caused my situation to:<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"ipt_uif_label_column column_1\">\n<input\nchecked=\"checked\"\t\t data-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][10][options][]\"\nid=\"ipt_fsqm_form_56_mcq_10_options__0\"\nvalue=\"0\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_10_options__0\" data-labelcon=\"&#xe18e;\">\nImprove\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][10][options][]\"\nid=\"ipt_fsqm_form_56_mcq_10_options__1\"\nvalue=\"1\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_10_options__1\" data-labelcon=\"&#xe18e;\">\nRemain the Same\t<\/label><\/div><div\nclass=\"ipt_uif_label_column column_1\">\n<input\ndata-num=\"\"\t\t\t\ttype=\"radio\"\nclass=\"check_me validate[required] ipt_uif_radio with-gap\"\nname=\"ipt_fsqm_form_56[mcq][10][options][]\"\nid=\"ipt_fsqm_form_56_mcq_10_options__2\"\nvalue=\"2\" \/>\n<label\nclass=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_56_mcq_10_options__2\" data-labelcon=\"&#xe18e;\">\nWorsen\t<\/label><\/div><div\nclass=\"clear-both\"><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[freetype][3][m_type]\" id=\"ipt_fsqm_form_56_freetype_3_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[freetype][3][type]\" id=\"ipt_fsqm_form_56_freetype_3_type\" value=\"feedback_large\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_large\" id=\"ipt_fsqm_form_56_freetype_3\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_56_freetype_3_value\">Additional Comments:<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field\"><textarea class=\"ipt_uif_textarea materialize-textarea  check_me validate[required]\"\n\t\trows=\"4\"\n\t\t\t\t\t\t\t\tname=\"ipt_fsqm_form_56[freetype][3][value]\"\n\t\tmaxlength=\"\"\t\tid=\"ipt_fsqm_form_56_freetype_3_value\"><\/textarea><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[freetype][4][m_type]\" id=\"ipt_fsqm_form_56_freetype_4_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_56[freetype][4][type]\" id=\"ipt_fsqm_form_56_freetype_4_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_56_freetype_4\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_56_freetype_4_value\">Run number:<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field\">\n<input\nclass=\" check_me validate[required] ipt_uif_text\"\ntype=\"text\"\nname=\"ipt_fsqm_form_56[freetype][4][value]\"\nid=\"ipt_fsqm_form_56_freetype_4_value\"\nmaxlength=\"\"\t\tvalue=\"\" \/><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear\"><\/div><div\nid=\"ipt_fsqm_form_56_button_container\" class=\"ipt_fsqm_form_button_container ipt_fsqm_form_button_container--classic ipt-eform-material-button-container\"><div\nclass=\"eform-button-container-inner\">\n<button\ntype=\"submit\" class=\"ipt_uif_button eform-material-button eform-ripple ipt_fsqm_form_button_submit medium primary-button\" name=\"ipt_fsqm_form_56_button_submit\" id=\"ipt_fsqm_form_56_button_submit\"> Submit<\/button><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><\/form><\/div><div\nstyle=\"display: none;\" class=\"ipt_fsqm_form_message_success ui-widget ui-widget-content ui-corner-all ipt_uif_widget_box\"><div\nclass=\"ui-helper-reset ui-helper-clearfix ui-widget-header ui-corner-all\"><h3><i\ntitle=\"\" class=\" ipt-icomoon-checkmark-circle ipticm prefix\"><\/i>\nYour form has been submitted<\/h3><\/div><div\nclass=\"ui-widget-content ui-corner-all ipt_fsqm_success_wrap\"><p>Thank you for completing our survey. We have received your submission. Feel free to give us a call if you would like to discuss your survey results at 903-291-2600.  We appreciate your feedback!<\/p><\/div><\/div><div\nstyle=\"display: none;\" class=\"ipt_fsqm_form_message_error ui-widget ui-widget-content ui-corner-all ipt_uif_widget_box\"><div\nclass=\"ui-helper-reset ui-helper-clearfix ui-widget-header ui-corner-all\"><div><i\ntitle=\"\" class=\" ipt-icomoon-laptop ipticm prefix\"><\/i>\nServer Side Error<\/div><\/div><div\nclass=\"ui-widget-content ui-corner-all\"><p>We faced problems while connecting to the server or receiving data from the server. Please wait for a few seconds and try again.<\/p><p>If the problem persists, then check your internet connectivity. If all other sites open fine, then please contact the administrator of this website with the following information.<\/p><p\nclass=\"jqXHR\">\n<strong>TextStatus: <\/strong><span\nclass=\"textStatus\">undefined<\/span><br\n\/>\n<strong>HTTP Error: <\/strong><span\nclass=\"errorThrown\">undefined<\/span><\/p><\/div><\/div><div\nstyle=\"display: none\" class=\"ipt_uif_widget_box ipt_fsqm_form_message_process\"><div\nclass=\"ui-widget ui-widget-header ui-corner-all\"><style type=\"text\/css\">.ipt_uif_ajax_loader,\n\t\t\t.ipt_uif_ajax_loader *,\n\t\t\tipt_uif_ajax_loader *::before,\n\t\t\tipt_uif_ajax_loader *::after {\n\t\t\t\tbox-sizing: border-box;\n\t\t\t}<\/style><div\nclass=\"ipt-eform-preloader-inline ipt_uif_ajax_loader\"><div\nclass=\"ipt-eform-preloader-inner\"><div\nclass=\"ipt-eform-preloader-circle\"><div\nclass=\"preloader-wrapper active\"><div\nclass=\"spinner-layer spinner-blue\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-red\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-yellow\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-green\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><\/div><\/div><div\nclass=\"ipt-eform-preloader-text\"><div\nclass=\"ipt-eform-preloader-text-inner ipt_uif_ajax_loader_text\">Processing you request<\/div><\/div><div\nclass=\"clear\"><\/div><\/div><\/div><\/div><\/div><div\nstyle=\"display: none;\" class=\"ipt_fsqm_form_validation_error ui-widget ui-widget-content ui-corner-all ipt_uif_widget_box\"><div\nclass=\"ui-helper-reset ui-helper-clearfix ui-widget-header ui-corner-all\"><div><i\ntitle=\"\" class=\" ipt-icomoon-warning2 ipticm prefix\"><\/i>\n<span\nclass=\"fsqm_ve_text\">Error<\/span><\/div><\/div><div\nclass=\"ui-widget-content ui-corner-all\"><p\nclass=\"fsqm_ve_msg\">Some error has occured.<\/p><\/div><\/div><\/div>\n<\/div>\n\t\t<\/div><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"<p>Patient\/Family Member -Emergency Survey<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":16,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-3918","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.christusems.org\/index.php?rest_route=\/wp\/v2\/pages\/3918","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.christusems.org\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.christusems.org\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.christusems.org\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.christusems.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3918"}],"version-history":[{"count":14,"href":"https:\/\/www.christusems.org\/index.php?rest_route=\/wp\/v2\/pages\/3918\/revisions"}],"predecessor-version":[{"id":4580,"href":"https:\/\/www.christusems.org\/index.php?rest_route=\/wp\/v2\/pages\/3918\/revisions\/4580"}],"wp:attachment":[{"href":"https:\/\/www.christusems.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3918"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}