{"id":80254,"date":"2023-11-28T11:57:23","date_gmt":"2023-11-28T16:57:23","guid":{"rendered":"https:\/\/www.ottawahospital.on.ca\/?page_id=80254"},"modified":"2024-07-16T09:34:32","modified_gmt":"2024-07-16T13:34:32","slug":"medical-affairs-prod-no-addresses","status":"publish","type":"page","link":"https:\/\/www.ottawahospital.on.ca\/en\/medical-affairs-prod-no-addresses\/","title":{"rendered":"Medical Affairs &#8211; PROD &#8211; No Addresses"},"content":{"rendered":"\n<div class=\"wp-block-contact-form-7-contact-form-selector\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f75981-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"75981\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/80254#wpcf7-f75981-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"75981\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.4\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f75981-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_extcf7_conditional_options\" value=\"{&quot;form_id&quot;:75981,&quot;conditions&quot;:[]}\" \/><input type=\"hidden\" name=\"_extcf7_redirect_options\" value=\"{&quot;form_id&quot;:75981,&quot;redirect_options&quot;:{&quot;redirection_enable&quot;:&quot;off&quot;,&quot;custom_url_enable&quot;:&quot;off&quot;,&quot;redirect_page&quot;:&quot;&quot;,&quot;custom_urle&quot;:&quot;&quot;,&quot;redirect_new_tab&quot;:&quot;off&quot;,&quot;js_action&quot;:&quot;off&quot;,&quot;javascript_code&quot;:&quot;&quot;}}\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<p><label> Name<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span> <\/label>\n<\/p>\n<p><label>Enter the name of the Payor\/Credit Card holder if different from above<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"othersname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"othersname\" \/><\/span><\/label>\n<\/p>\n<p><label> Email<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span> <\/label>\n<\/p>\n<p><label> Department<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"department\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"department\" \/><\/span> <\/label>\n<\/p>\n<p><label> Division<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"division\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"division\" \/><\/span> <\/label>\n<\/p>\n<p><label> Fee Type<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"fee-type\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required gpsFee\" aria-required=\"true\" aria-invalid=\"false\" name=\"fee-type\"><option value=\"\">Select Fee Type<\/option><option value=\"New Appointment Processing Fee - $100\">New Appointment Processing Fee - $100<\/option><option value=\"Observer Processing Fee - $100\">Observer Processing Fee - $100<\/option><option value=\"Reappointment Admin fee for Late Reappointment and\/or Conflict of Interest Forms - $300.00\">Reappointment Admin fee for Late Reappointment and\/or Conflict of Interest Forms - $300.00<\/option><option value=\"Reappointment Admin Fee for Late Forms and ELM Training Modules - $600.00\">Reappointment Admin Fee for Late Forms and ELM Training Modules - $600.00<\/option><\/select><\/span> <\/label>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" id=\"gpsCreditCardSubmit\" type=\"submit\" value=\"Submit\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":25,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template_gps_form_no_address.php","meta":{"_acf_changed":false,"_mc_calendar":[],"footnotes":""},"class_list":["post-80254","page","type-page","status-publish","hentry"],"acf":[],"wps_subtitle":"","_links":{"self":[{"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/pages\/80254","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/users\/25"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/comments?post=80254"}],"version-history":[{"count":0,"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/pages\/80254\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/media?parent=80254"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}