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432 lines
12 KiB
432 lines
12 KiB
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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confirmation_back_label: '' |
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confirmation_back_attributes: { } |
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confirmation_exclude_query: false |
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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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limit_total_message: '' |
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limit_total_unique: false |
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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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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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results_disabled: false |
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results_disabled_ignore: false |
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results_customize: false |
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token_view: false |
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token_update: false |
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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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- anonymous |
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- authenticated |
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users: { } |
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permissions: { } |
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view_any: |
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roles: { } |
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users: { } |
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permissions: { } |
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update_any: |
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roles: { } |
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users: { } |
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permissions: { } |
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delete_any: |
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roles: { } |
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users: { } |
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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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view_own: |
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roles: { } |
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users: { } |
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permissions: { } |
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update_own: |
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roles: { } |
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users: { } |
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permissions: { } |
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delete_own: |
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roles: { } |
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users: { } |
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permissions: { } |
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administer: |
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roles: { } |
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users: { } |
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permissions: { } |
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test: |
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roles: { } |
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users: { } |
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permissions: { } |
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configuration: |
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roles: { } |
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users: { } |
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permissions: { } |
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handlers: |
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email_notification: |
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id: email |
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label: 'Email notification' |
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notes: '' |
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handler_id: email_notification |
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status: true |
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conditions: { } |
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weight: 0 |
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settings: |
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states: |
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- completed |
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to_mail: _default |
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to_options: { } |
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cc_mail: '' |
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cc_options: { } |
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bcc_mail: '' |
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bcc_options: { } |
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from_mail: '[webform_submission:values:email:raw]' |
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from_options: { } |
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from_name: '[webform_submission:values:name:raw]' |
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subject: '[webform_submission:values:subject:raw]' |
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body: '[webform_submission:values:message:value]' |
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excluded_elements: { } |
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ignore_access: false |
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exclude_empty: true |
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exclude_empty_checkbox: false |
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exclude_attachments: false |
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html: true |
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attachments: false |
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twig: false |
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theme_name: '' |
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parameters: { } |
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debug: false |
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reply_to: '' |
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return_path: '' |
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sender_mail: '' |
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sender_name: '' |
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variants: { }
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