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433 lines
12 KiB
433 lines
12 KiB
2 years ago
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uuid: 2536fe1e-651d-4c6c-874b-8d5535eb21c2
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langcode: en
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status: closed
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dependencies:
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enforced:
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module:
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- webform_templates
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_core:
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default_config_hash: tHlVBW0O7k8JVIDYgEeBqMdm152lxE0cTZmdEICs3-c
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open: null
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close: null
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weight: 0
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uid: null
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template: true
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archive: false
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id: template_medical_appointment
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title: 'Request a Medical Appointment'
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description: 'A medical appointment request webform template.'
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category: ''
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elements: |
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introduction:
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'#markup': 'After you submit the form, a care specialist will call you back within XX hours to schedule an appointment.'
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hr:
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'#type': webform_horizontal_rule
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call:
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'#markup': 'You may also speak with a care specialist directly by calling <a href="tel:XXX-XXX-XXXX">XXX-XXX-XXXX</a> on Monday–Friday between 8:30 am to 5:00 pm EST.'
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general:
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'#type': fieldset
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'#title': 'General Information'
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'#title_display': invisible
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'#attributes':
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style: 'background-color: #efefef'
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type:
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'#type': radios
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'#title': 'Who are you?'
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'#options':
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Patient: Patient
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Caregiver: Caregiver
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'#options_display': buttons
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'#required': true
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relationship:
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'#type': webform_select_other
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'#title': 'What is your relationship to the patient?'
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'#options': relationship
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'#states':
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visible:
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':input[name="type"]':
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value: Caregiver
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required:
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':input[name="type"]':
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value: Caregiver
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caregiver:
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'#type': fieldset
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'#title': 'Your Information'
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'#states':
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visible:
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':input[name="type"]':
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value: Caregiver
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caregiver_name:
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'#type': webform_flexbox
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caregiver_first_name:
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'#title': 'Your First Name'
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'#type': textfield
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'#states':
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required:
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':input[name="type"]':
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value: Caregiver
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caregiver_last_name:
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'#title': 'Your Last Name'
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'#type': textfield
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'#states':
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required:
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':input[name="type"]':
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value: Caregiver
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'#title': 'Your Name'
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caregiver_contact:
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'#type': webform_flexbox
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caregiver_email:
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'#title': 'Your Email'
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'#type': email
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'#states':
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required:
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':input[name="type"]':
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value: Caregiver
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caregiver_phone:
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'#title': 'Your Phone'
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'#type': tel
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'#placeholder': 000-000-0000
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'#states':
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required:
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':input[name="type"]':
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value: Caregiver
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caregiver_phone_preferences:
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'#type': webform_custom_composite
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'#title': 'Your Phone Preferences'
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'#description': |
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Please select the best days and times for us to call you.<br/>
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<em>Leave blank if you have no preferences.</em>
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'#description_display': before
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'#multiple__min_items': '3'
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'#multiple__sorting': false
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'#multiple__operations': false
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'#multiple__add_more': false
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'#element':
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day:
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'#type': select
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'#options':
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Monday: Monday
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Tuesday: Tuesday
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Wednesday: Wednesday
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Thursday: Thursday
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Friday: Fridate
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'#title': 'Day of the Week'
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'#empty_option': 'Any day of the week'
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time:
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'#type': select
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'#options':
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'8am-10am EST': '8am-10am EST'
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'10am-12pm EST': '10am-12pm EST'
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'12pm-2pm EST': '12pm-2pm EST'
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'2pm-4pm EST': '2pm-4pm EST'
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'#title': 'Time of Day'
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'#empty_option': 'Any time of the day'
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patient:
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'#type': fieldset
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'#title': 'Patient Information'
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patient_name:
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'#type': webform_flexbox
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patient_first_name:
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'#title': 'Patient First Name'
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'#type': textfield
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'#required': true
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patient_last_name:
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'#title': 'Patient Last Name'
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'#type': textfield
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'#required': true
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patient_contact:
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'#type': webform_flexbox
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patient_email:
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'#title': 'Patient Email'
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'#type': email
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'#states':
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required:
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':input[name="type"]':
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'!value': Caregiver
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patient_phone:
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'#title': 'Patient Phone'
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'#type': tel
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'#required': true
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'#placeholder': 000-000-0000
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'#states':
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required:
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':input[name="type"]':
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'!value': Caregiver
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patient_phone_preferences:
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'#type': webform_custom_composite
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'#title': 'Patient Phone Preferences'
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'#description': |
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Please select the best days and times for us to call the patient.<br/>
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<em>Leave blank if the patient has no preferences.</em>'
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'#description_display': before
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'#multiple__min_items': '3'
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'#multiple__sorting': false
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'#multiple__operations': false
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'#multiple__add_more': false
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'#element':
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day:
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'#type': select
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'#options':
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Monday: Monday
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Tuesday: Tuesday
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Wednesday: Wednesday
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Thursday: Thursday
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Friday: Fridate
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'#title': 'Day of the Week'
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'#empty_option': 'Any day of the week'
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time:
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'#type': select
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'#options':
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'8am-10am EST': '8am-10am EST'
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'10am-12pm EST': '10am-12pm EST'
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'12pm-2pm EST': '12pm-2pm EST'
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'2pm-4pm EST': '2pm-4pm EST'
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'#title': 'Time of Day'
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'#empty_option': 'Any time of the day'
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appointment:
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'#type': fieldset
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'#title': 'Appointment Information (optional)'
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medical:
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'#type': textarea
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'#title': 'Please provide information about your medical needs'
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'#rows': 3
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insurance:
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'#type': textfield
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'#title': 'Please provide insurance plan name information'''
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referral:
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'#type': checkbox
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'#title': 'Have you been referred by a physician?'
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physician:
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'#type': textarea
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'#title': 'Please provide information about the referring physician'
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'#rows': 3
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'#states':
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visible:
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':input[name="referral"]':
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checked: true
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actions:
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'#type': webform_actions
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'#title': 'Submit button(s)'
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'#submit__label': 'Send Request'
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css: ''
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javascript: ''
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settings:
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ajax: false
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ajax_scroll_top: form
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ajax_progress_type: ''
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ajax_effect: ''
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ajax_speed: null
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page: true
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page_submit_path: ''
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page_confirm_path: ''
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page_theme_name: ''
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form_title: source_entity_webform
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form_submit_once: false
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form_exception_message: ''
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form_open_message: ''
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form_close_message: ''
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form_previous_submissions: true
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form_confidential: false
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form_confidential_message: ''
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form_disable_remote_addr: false
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form_convert_anonymous: false
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form_prepopulate: false
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form_prepopulate_source_entity: false
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form_prepopulate_source_entity_required: false
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form_prepopulate_source_entity_type: ''
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form_reset: false
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form_disable_autocomplete: false
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form_novalidate: false
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form_disable_inline_errors: false
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form_required: true
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form_unsaved: true
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form_disable_back: false
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form_submit_back: false
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form_autofocus: false
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form_details_toggle: false
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form_access_denied: default
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form_access_denied_title: ''
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form_access_denied_message: ''
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form_access_denied_attributes: { }
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form_file_limit: ''
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form_method: ''
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form_action: ''
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form_attributes: { }
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share: false
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share_node: false
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share_theme_name: ''
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share_title: true
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share_page_body_attributes: { }
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submission_label: ''
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submission_log: false
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submission_views: { }
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submission_views_replace: { }
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submission_user_columns: { }
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submission_user_duplicate: false
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submission_access_denied: default
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submission_access_denied_title: ''
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submission_access_denied_message: ''
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submission_access_denied_attributes: { }
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submission_exception_message: ''
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submission_locked_message: ''
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submission_excluded_elements: { }
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submission_exclude_empty: false
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submission_exclude_empty_checkbox: false
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previous_submission_message: ''
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previous_submissions_message: ''
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autofill: false
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autofill_message: ''
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autofill_excluded_elements: { }
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wizard_progress_bar: true
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wizard_progress_pages: false
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wizard_progress_percentage: false
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wizard_progress_link: false
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wizard_progress_states: false
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wizard_auto_forward: true
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wizard_auto_forward_hide_next_button: false
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wizard_keyboard: true
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wizard_start_label: ''
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wizard_preview_link: false
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wizard_confirmation: true
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wizard_confirmation_label: ''
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wizard_track: ''
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wizard_prev_button_label: ''
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wizard_next_button_label: ''
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wizard_toggle: false
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wizard_toggle_show_label: ''
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wizard_toggle_hide_label: ''
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preview: 0
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preview_label: ''
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preview_title: ''
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preview_message: ''
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preview_attributes: { }
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preview_excluded_elements: { }
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preview_exclude_empty: true
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preview_exclude_empty_checkbox: false
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draft: none
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draft_multiple: false
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draft_auto_save: false
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draft_saved_message: ''
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draft_loaded_message: ''
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draft_pending_single_message: ''
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draft_pending_multiple_message: ''
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confirmation_type: page
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confirmation_title: 'Thank You'
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confirmation_message: 'Your request has been sent. A care specialist will call you back within XX hours to schedule an appointment.'
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confirmation_url: '<front>'
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confirmation_attributes: { }
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confirmation_back: false
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||
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confirmation_back_label: ''
|
||
|
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confirmation_back_attributes: { }
|
||
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confirmation_exclude_query: false
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||
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confirmation_exclude_token: false
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confirmation_update: false
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limit_total: null
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limit_total_interval: null
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||
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limit_total_message: ''
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||
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limit_total_unique: false
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||
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limit_user: null
|
||
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limit_user_interval: null
|
||
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limit_user_message: ''
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||
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limit_user_unique: false
|
||
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entity_limit_total: null
|
||
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entity_limit_total_interval: null
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entity_limit_user: null
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entity_limit_user_interval: null
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purge: none
|
||
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purge_days: null
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||
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results_disabled: false
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||
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results_disabled_ignore: false
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||
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results_customize: false
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||
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token_view: false
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||
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token_update: false
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||
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token_delete: false
|
||
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serial_disabled: false
|
||
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access:
|
||
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create:
|
||
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roles:
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||
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- anonymous
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||
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- authenticated
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||
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users: { }
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||
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permissions: { }
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||
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view_any:
|
||
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roles: { }
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||
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users: { }
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||
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permissions: { }
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||
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update_any:
|
||
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roles: { }
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||
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users: { }
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||
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permissions: { }
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||
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delete_any:
|
||
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roles: { }
|
||
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users: { }
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||
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permissions: { }
|
||
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purge_any:
|
||
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roles: { }
|
||
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users: { }
|
||
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permissions: { }
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||
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|
view_own:
|
||
|
|
roles: { }
|
||
|
|
users: { }
|
||
|
|
permissions: { }
|
||
|
|
update_own:
|
||
|
|
roles: { }
|
||
|
|
users: { }
|
||
|
|
permissions: { }
|
||
|
|
delete_own:
|
||
|
|
roles: { }
|
||
|
|
users: { }
|
||
|
|
permissions: { }
|
||
|
|
administer:
|
||
|
|
roles: { }
|
||
|
|
users: { }
|
||
|
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permissions: { }
|
||
|
|
test:
|
||
|
|
roles: { }
|
||
|
|
users: { }
|
||
|
|
permissions: { }
|
||
|
|
configuration:
|
||
|
|
roles: { }
|
||
|
|
users: { }
|
||
|
|
permissions: { }
|
||
|
|
handlers:
|
||
|
|
email_notification:
|
||
|
|
id: email
|
||
|
|
label: 'Email notification'
|
||
|
|
notes: ''
|
||
|
|
handler_id: email_notification
|
||
|
|
status: true
|
||
|
|
conditions: { }
|
||
|
|
weight: 0
|
||
|
|
settings:
|
||
|
|
states:
|
||
|
|
- completed
|
||
|
|
to_mail: _default
|
||
|
|
to_options: { }
|
||
|
|
cc_mail: ''
|
||
|
|
cc_options: { }
|
||
|
|
bcc_mail: ''
|
||
|
|
bcc_options: { }
|
||
|
|
from_mail: '[webform_submission:values:email:raw]'
|
||
|
|
from_options: { }
|
||
|
|
from_name: '[webform_submission:values:name:raw]'
|
||
|
|
subject: '[webform_submission:values:subject:raw]'
|
||
|
|
body: '[webform_submission:values:message:value]'
|
||
|
|
excluded_elements: { }
|
||
|
|
ignore_access: false
|
||
|
|
exclude_empty: true
|
||
|
|
exclude_empty_checkbox: false
|
||
|
|
exclude_attachments: false
|
||
|
|
html: true
|
||
|
|
attachments: false
|
||
|
|
twig: false
|
||
|
|
theme_name: ''
|
||
|
|
parameters: { }
|
||
|
|
debug: false
|
||
|
|
reply_to: ''
|
||
|
|
return_path: ''
|
||
|
|
sender_mail: ''
|
||
|
|
sender_name: ''
|
||
|
|
variants: { }
|