{"id":10068,"date":"2025-07-21T04:16:30","date_gmt":"2025-07-21T04:16:30","guid":{"rendered":"https:\/\/uat.tzuchi.org.sg\/medical-assistance-web-form\/"},"modified":"2026-06-07T09:24:49","modified_gmt":"2026-06-07T09:24:49","slug":"medical-assistance-web-form","status":"publish","type":"page","link":"https:\/\/uat.tzuchi.org.sg\/zh-hans\/medical-assistance-web-form\/","title":{"rendered":"Medical Assistance Web Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"10068\" class=\"elementor elementor-10068 elementor-1968\" data-elementor-settings=\"{&quot;ha_cmc_init_switcher&quot;:&quot;no&quot;}\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-0b695de e-flex e-con-boxed e-con e-parent\" data-id=\"0b695de\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c4b7e90 elementor-widget elementor-widget-heading\" data-id=\"c4b7e90\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Apply for Medical Assistance<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d147a63 elementor-widget__width-initial elementor-widget elementor-widget-text-editor\" data-id=\"d147a63\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>xxx<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-7eff2d9 steps-form e-flex e-con-boxed e-con e-parent\" data-id=\"7eff2d9\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-559fd36 e-con-full e-flex e-con e-child\" data-id=\"559fd36\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-11ed4dc elementor-button-align-center elementor-widget elementor-widget-form\" data-id=\"11ed4dc\" data-element_type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Continue&quot;,&quot;step_previous_label&quot;:&quot;Back&quot;,&quot;step_type&quot;:&quot;number&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"New Form\" aria-label=\"New Form\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"10068\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"11ed4dc\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Medical Assistance Web Form\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"10068\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_26e4dbc elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-email elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tApplying for yourself or on behalf of someone else \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Self\" id=\"form-field-email-0\" name=\"form_fields[email][]\"> <label for=\"form-field-email-0\">Self<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"On behalf\" id=\"form-field-email-1\" name=\"form_fields[email][]\"> <label for=\"form-field-email-1\">On behalf<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Yes\" id=\"form-field-email-2\" name=\"form_fields[email][]\"> <label for=\"form-field-email-2\">Yes<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_db59d86 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_db59d86\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDid you obtain the applicant\u2019s consent to share their personal information for this referral?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Yes\" id=\"form-field-field_db59d86-0\" name=\"form_fields[field_db59d86][]\"> <label for=\"form-field-field_db59d86-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"No\" id=\"form-field-field_db59d86-1\" name=\"form_fields[field_db59d86][]\"> <label for=\"form-field-field_db59d86-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_c164e97 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c164e97\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tReferring Person \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_c164e97]\" id=\"form-field-field_c164e97\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Enter Referring Person\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-number elementor-field-group elementor-column elementor-field-group-field_4d20a01 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4d20a01\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tReferring Person's Contact Number \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[field_4d20a01]\" id=\"form-field-field_4d20a01\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Enter Referring Person&#039;s Contact Number\" required=\"required\" min=\"\" max=\"\" >\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_1f84f07 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1f84f07\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tReferring Person's Email *\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_1f84f07]\" id=\"form-field-field_1f84f07\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Enter Referring Person&#039;s Email *\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_4f62a54 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_7dfb21b elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7dfb21b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tReferring Person's Email \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_7dfb21b]\" id=\"form-field-field_7dfb21b\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Enter Referring Person&#039;s Email\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_9d0e9f7 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9d0e9f7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tApplicant\u2019s Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_9d0e9f7]\" id=\"form-field-field_9d0e9f7\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Enter Applicant\u2019s Name\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_d295831 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ffe8149 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ffe8149\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tApplicant\u2019s Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ffe8149]\" id=\"form-field-field_ffe8149\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Enter Applicant\u2019s Name\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-recaptcha_v3 elementor-field-group elementor-column elementor-field-group-field_352517f elementor-col-100 recaptcha_v3-bottomright\">\n\t\t\t\t\t<div class=\"elementor-field\" id=\"form-field-field_352517f\"><div class=\"elementor-g-recaptcha\" data-sitekey=\"6Lc0EZwrAAAAAAoMNIT46rgp9Bt06PHYzl9M51SW\" data-type=\"v3\" data-action=\"Form\" data-badge=\"bottomright\" data-size=\"invisible\"><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Send<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Apply for Medical Assistance x [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-10068","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/uat.tzuchi.org.sg\/zh-hans\/wp-json\/wp\/v2\/pages\/10068","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/uat.tzuchi.org.sg\/zh-hans\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/uat.tzuchi.org.sg\/zh-hans\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/uat.tzuchi.org.sg\/zh-hans\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/uat.tzuchi.org.sg\/zh-hans\/wp-json\/wp\/v2\/comments?post=10068"}],"version-history":[{"count":12,"href":"https:\/\/uat.tzuchi.org.sg\/zh-hans\/wp-json\/wp\/v2\/pages\/10068\/revisions"}],"predecessor-version":[{"id":35863,"href":"https:\/\/uat.tzuchi.org.sg\/zh-hans\/wp-json\/wp\/v2\/pages\/10068\/revisions\/35863"}],"wp:attachment":[{"href":"https:\/\/uat.tzuchi.org.sg\/zh-hans\/wp-json\/wp\/v2\/media?parent=10068"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}