{"id":5841,"date":"2018-08-13T22:33:19","date_gmt":"2018-08-13T22:33:19","guid":{"rendered":"https:\/\/radiologyassist.com\/forms\/?page_id=5841"},"modified":"2023-04-26T01:03:25","modified_gmt":"2023-04-26T06:03:25","slug":"upload-records","status":"publish","type":"page","link":"https:\/\/radiologyassist.com\/forms\/upload-records\/","title":{"rendered":"Upload Records"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" 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-0 fusion_builder_column_2_3 2_3 fusion-two-third fusion-column-first\" style=\"width:65.3333%; margin-right: 4%;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;\">\n                <div class='gf_browser_gecko gform_wrapper' id='gform_wrapper_7' ><form method='post' enctype='multipart\/form-data'  id='gform_7'  action='\/forms\/wp-json\/wp\/v2\/pages\/5841'>\n                        <div class='gform_body'><ul id='gform_fields_7' class='gform_fields top_label form_sublabel_above description_above'><li id='field_7_2'  class='gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above field_description_above gfield_visibility_visible' >This form can be used to securely upload scripts, medical records or reports.<\/li><li id='field_7_5'  class='gfield gfield_contains_required field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label'  >File<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_7_5' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_7_5&quot;,&quot;container&quot;:&quot;gform_multifile_upload_7_5&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_7_5&quot;,&quot;filelist&quot;:&quot;gform_preview_7_5&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/radiologyassist.com\\\/forms\\\/?gf_page=f1941d88fa557c5&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/radiologyassist.com\\\/forms\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/radiologyassist.com\\\/forms\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;jpg,jpeg,gif,png,pdf&quot;}],&quot;max_file_size&quot;:&quot;12582912b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:7,&quot;field_id&quot;:5},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;8&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_7_5&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_7_5' class='gform_drop_area'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<input id='gform_browse_button_7_5' type='button' value='Select files' class='button gform_button_select_files' aria-describedby='extensions_message_7_5'  \/>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span id='extensions_message_7_5' class='screen-reader-text'>Accepted file types: jpg, jpeg, gif, png, pdf.<\/span><div class='validation_message'>\n\t\t\t\t\t\t\t\t<ul id='gform_multifile_messages_7_5'>\n\t\t\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t\t<\/div><\/div><div id='gform_preview_7_5'><\/div><\/li><li id='field_7_8'  class='gfield field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_7_8' >Patient ID<\/label><div class='gfield_description' id='gfield_description_7_8'>If known<\/div><div class='ginput_container ginput_container_text'><input name='input_8' id='input_7_8' type='text' value='' class='medium'  aria-describedby=\"gfield_description_7_8\"    aria-invalid=\"false\" \/><\/div><\/li><li id='field_7_6'  class='gfield field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_7_6' >Patient Name<\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_7_6' type='text' value='' class='medium'      aria-invalid=\"false\" \/><\/div><\/li><li id='field_7_4'  class='gfield field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_7_4' >Phone<\/label><div class='gfield_description' id='gfield_description_7_4'>Please provide a phone number for us to contact you in case we have a question.<\/div><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_7_4' type='text' value='' class='medium'    aria-invalid=\"false\" aria-describedby=\"gfield_description_7_4\" \/><\/div><\/li><li id='field_7_7'  class='gfield field_sublabel_above field_description_above gfield_visibility_hidden' ><label class='gfield_label' for='input_7_7' >Additional instructions<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_7' id='input_7_7' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id='field_7_9'  class='gfield gform_validation_container field_sublabel_above field_description_above gfield_visibility_visible' ><label class='gfield_label' for='input_7_9' >Name<\/label><div class='gfield_description' id='gfield_description__9'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_9' id='input_7_9' type='text' value='' \/><\/div><\/li>\n                            <\/ul><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_7' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_7\"]){return false;}  window[\"gf_submitting_7\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_7\"]){return false;} window[\"gf_submitting_7\"]=true;  jQuery(\"#gform_7\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_7' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='7' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_7' value='WyJbXSIsIjE5YTJkMzU3N2NiYzdlZWIxY2M5NmJjYjQyNDI1NDllIl0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_7' id='gform_target_page_number_7' value='0' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_7' id='gform_source_page_number_7' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            <input type='hidden' name='gform_uploaded_files' id='gform_uploaded_files_7' value='' \/>\n        <\/div>\n                        <\/form>\n                        <\/div><script type='text\/javascript'> jQuery(document).bind('gform_post_render', function(event, formId, currentPage){if(formId == 7) {jQuery('#input_7_4').mask('(999) 999-9999').bind('keypress', function(e){if(e.which == 13){jQuery(this).blur();} } );} } );jQuery(document).bind('gform_post_conditional_logic', function(event, formId, fields, isInit){} );<\/script><script type='text\/javascript'> jQuery(document).ready(function(){jQuery(document).trigger('gform_post_render', [7, 1]) } ); <\/script><div class=\"fusion-clearfix\"><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_3 1_3 fusion-one-third fusion-column-last\" style=\"width:30.6666%;margin-top:0px;margin-bottom:20px;\"><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;background-color:#f6f6f6;padding: 0px 0px 270px 0px;\"><div class=\"fusion-text fusion-text-1\"><div style=\"color: #4d4d4d; padding: 10px;\">\n<h2 style=\"color: #4d4d4d;\">Instructions<\/h2>\n<p style=\"color: #4d4d4d; font-size: 90%;\">Please use the secure upload form on the left to upload your physician script or order to RadiologyAssist.<\/p>\n<h2 style=\"color: #4d4d4d;\">Appointment Scheduling<\/h2>\n<p style=\"color: #4d4d4d; font-size: 90%;\">Appointments are scheduled within 4 business hours of uploading your referral. If you have not completed an appointment request as yet, please complete an appointment request after uploading the document.<\/p>\n<h2 style=\"color: #4d4d4d;\">Support<\/h2>\n<p style=\"color: #4d4d4d; font-size: 90%;\">For support, please call 1-855-346-5152. We are available Monday &#8211; Friday 9am to 4:30pm<\/p>\n<p style=\"color: #4d4d4d; font-size: 90%;\">\n<\/div>\n<\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"background-color: rgba(255,255,255,0);background-position: center center;background-repeat: no-repeat;border-width: 0px 0px 0px 0px;border-color:#eae9e9;border-style:solid;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start\" style=\"max-width:1154.4px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_1 1_1 fusion-flex-column\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\" 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-2\">\n<\/div><\/div><style type=\"text\/css\">.fusion-body .fusion-builder-column-2{width:100% !important;margin-top : 0px;margin-bottom : 20px;}.fusion-builder-column-2 > .fusion-column-wrapper {padding-top : 0px !important;padding-right : 0px !important;margin-right : 1.92%;padding-bottom : 0px !important;padding-left : 0px !important;margin-left : 1.92%;}@media only screen and (max-width:1024px) {.fusion-body .fusion-builder-column-2{width:100% !important;order : 0;}.fusion-builder-column-2 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}@media only screen and (max-width:640px) {.fusion-body .fusion-builder-column-2{width:100% !important;order : 0;}.fusion-builder-column-2 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}<\/style><\/div><\/div><style type=\"text\/css\">.fusion-body .fusion-flex-container.fusion-builder-row-2{ padding-top : 0px;margin-top : 0px;padding-right : 0px;padding-bottom : 0px;margin-bottom : 0px;padding-left : 0px;}<\/style><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":24,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/radiologyassist.com\/forms\/wp-json\/wp\/v2\/pages\/5841"}],"collection":[{"href":"https:\/\/radiologyassist.com\/forms\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/radiologyassist.com\/forms\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/radiologyassist.com\/forms\/wp-json\/wp\/v2\/users\/24"}],"replies":[{"embeddable":true,"href":"https:\/\/radiologyassist.com\/forms\/wp-json\/wp\/v2\/comments?post=5841"}],"version-history":[{"count":7,"href":"https:\/\/radiologyassist.com\/forms\/wp-json\/wp\/v2\/pages\/5841\/revisions"}],"predecessor-version":[{"id":50634,"href":"https:\/\/radiologyassist.com\/forms\/wp-json\/wp\/v2\/pages\/5841\/revisions\/50634"}],"wp:attachment":[{"href":"https:\/\/radiologyassist.com\/forms\/wp-json\/wp\/v2\/media?parent=5841"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}