{"id":1530,"date":"2016-01-28T14:42:08","date_gmt":"2016-01-28T19:42:08","guid":{"rendered":"https:\/\/med.virginia.edu\/pediatrics\/?page_id=1530"},"modified":"2016-01-28T15:12:52","modified_gmt":"2016-01-28T20:12:52","slug":"electronic-consultation-form","status":"publish","type":"page","link":"https:\/\/med.virginia.edu\/pediatrics\/electronic-consultation-form\/","title":{"rendered":"Pediatric Genetics Electronic Consultation Form"},"content":{"rendered":"<h6>William Wilson, M.D.<br \/>\nDivision of Pediatric Genetics<br \/>\nUVA Health System, P.O. Box 800386<br \/>\nCharlottesville, Virginia 22908<br \/>\n434-924-2665<\/h6>\n<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_2' >\n                        <div class='gform_heading'>\n                            <p class='gform_description'>Please Note: Information transmitted over the Internet is not secure, thus confidentiality cannot be guaranteed. Please note that information provided on this site is general medical educational information. If you have questions about a specific child, please remember that the child is not our patient and we have not seen the child to evaluate his or her actual medical condition. As such, any information we provide to you is general educational information and you may need to consult your physician for decision-making regarding the child's care.<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_2'  action='\/pediatrics\/wp-json\/wp\/v2\/pages\/1530' data-formid='2' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LebeGYrAAAAAP5BASaCDpdLeg5wBa6YY3ZS7nZh' data-tabindex='0'><input id=\"input_b39d2090254f3bd186a1afba0f143234\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_b39d2090254f3bd186a1afba0f143234\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><ul id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_2_1\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_2_1'>\n                            \n                            <span id='input_2_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_2_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_2_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_2_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_2_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_2_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_2_2\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_2'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_2' id='input_2_2' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_2_3\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_3'>Your Location (city, state, country)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_2_3' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_4\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_4'>Choose the personal category that best describes you:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_4' id='input_2_4' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Patient' >Patient<\/option><option value='Parent' >Parent<\/option><option value='Grandparent or guardian' >Grandparent or guardian<\/option><option value='Physician' >Physician<\/option><option value='Nurse or other health care professional' >Nurse or other health care professional<\/option><option value='Teacher' >Teacher<\/option><option value='Other' >Other<\/option><\/select><\/div><\/li><li id=\"field_2_5\" class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_5'>What is your question?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_5' id='input_2_5' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_2' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_2' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_2' id='gform_theme_2' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_2' id='gform_style_settings_2' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_2' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='2' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_2' value='WyJbXSIsIjZhNDI3YTVhMGI3YTczOWVkMWU0Y2JmODkxODE2MGNiIl0=' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_2' id='gform_target_page_number_2' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_2' id='gform_source_page_number_2' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"ak_\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"230\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><\/form>\n                        <\/div><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 2, 'https:\/\/med.virginia.edu\/pediatrics\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_2').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_2');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_2').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_2').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_2').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_2').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/  }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_2').val();gformInitSpinner( 2, 'https:\/\/med.virginia.edu\/pediatrics\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [2, current_page]);window['gf_submitting_2'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_2').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [2]);window['gf_submitting_2'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_2').text());}else{jQuery('#gform_2').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"2\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_2\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_2\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_2\" );        let postRenderFired = false;        function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            gform.core.triggerPostRenderEvents( 2, current_page );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) func.apply( context, args );                };                var callNow = immediate && !timeout;                clearTimeout( timeout );                timeout = setTimeout( later, wait );                if ( callNow ) func.apply( context, args );            };        }        const debouncedTriggerPostRender = debounce( function() {            triggerPostRender();        }, 200 );        if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) {            const observer = new MutationObserver( ( mutations ) => {                mutations.forEach( ( mutation ) => {                    if ( mutation.type === 'attributes' && visibilityTestDiv.offsetParent !== null ) {                        debouncedTriggerPostRender();                        observer.disconnect();                    }                });            });            observer.observe( document.body, {                attributes: true,                childList: false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} ); \n\/* ]]> *\/\n<\/script>\n\n","protected":false},"excerpt":{"rendered":"<p>William Wilson, M.D. Division of Pediatric Genetics UVA Health System, P.O. Box 800386 Charlottesville, Virginia 22908 434-924-2665<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":38,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":"","_links_to":"","_links_to_target":""},"tags":[],"class_list":["post-1530","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.1.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Pediatric Genetics Electronic Consultation Form - Department of Pediatrics<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/med.virginia.edu\/pediatrics\/electronic-consultation-form\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Pediatric Genetics Electronic Consultation Form - Department of Pediatrics\" \/>\n<meta property=\"og:description\" content=\"William Wilson, M.D. Division of Pediatric Genetics UVA Health System, P.O. Box 800386 Charlottesville, Virginia 22908 434-924-2665\" \/>\n<meta property=\"og:url\" content=\"https:\/\/med.virginia.edu\/pediatrics\/electronic-consultation-form\/\" \/>\n<meta property=\"og:site_name\" content=\"Department of Pediatrics\" \/>\n<meta property=\"article:modified_time\" content=\"2016-01-28T20:12:52+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/med.virginia.edu\/pediatrics\/electronic-consultation-form\/\",\"url\":\"https:\/\/med.virginia.edu\/pediatrics\/electronic-consultation-form\/\",\"name\":\"Pediatric Genetics Electronic Consultation Form - Department of Pediatrics\",\"isPartOf\":{\"@id\":\"https:\/\/med.virginia.edu\/pediatrics\/#website\"},\"datePublished\":\"2016-01-28T19:42:08+00:00\",\"dateModified\":\"2016-01-28T20:12:52+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/med.virginia.edu\/pediatrics\/electronic-consultation-form\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/med.virginia.edu\/pediatrics\/electronic-consultation-form\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/med.virginia.edu\/pediatrics\/electronic-consultation-form\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/med.virginia.edu\/pediatrics\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Pediatric Genetics Electronic Consultation Form\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/med.virginia.edu\/pediatrics\/#website\",\"url\":\"https:\/\/med.virginia.edu\/pediatrics\/\",\"name\":\"Department of Pediatrics\",\"description\":\"University of Virginia School of Medicine\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/med.virginia.edu\/pediatrics\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Pediatric Genetics Electronic Consultation Form - Department of Pediatrics","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/med.virginia.edu\/pediatrics\/electronic-consultation-form\/","og_locale":"en_US","og_type":"article","og_title":"Pediatric Genetics Electronic Consultation Form - Department of Pediatrics","og_description":"William Wilson, M.D. Division of Pediatric Genetics UVA Health System, P.O. Box 800386 Charlottesville, Virginia 22908 434-924-2665","og_url":"https:\/\/med.virginia.edu\/pediatrics\/electronic-consultation-form\/","og_site_name":"Department of Pediatrics","article_modified_time":"2016-01-28T20:12:52+00:00","twitter_card":"summary_large_image","schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/med.virginia.edu\/pediatrics\/electronic-consultation-form\/","url":"https:\/\/med.virginia.edu\/pediatrics\/electronic-consultation-form\/","name":"Pediatric Genetics Electronic Consultation Form - Department of Pediatrics","isPartOf":{"@id":"https:\/\/med.virginia.edu\/pediatrics\/#website"},"datePublished":"2016-01-28T19:42:08+00:00","dateModified":"2016-01-28T20:12:52+00:00","breadcrumb":{"@id":"https:\/\/med.virginia.edu\/pediatrics\/electronic-consultation-form\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/med.virginia.edu\/pediatrics\/electronic-consultation-form\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/med.virginia.edu\/pediatrics\/electronic-consultation-form\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/med.virginia.edu\/pediatrics\/"},{"@type":"ListItem","position":2,"name":"Pediatric Genetics Electronic Consultation Form"}]},{"@type":"WebSite","@id":"https:\/\/med.virginia.edu\/pediatrics\/#website","url":"https:\/\/med.virginia.edu\/pediatrics\/","name":"Department of Pediatrics","description":"University of Virginia School of Medicine","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/med.virginia.edu\/pediatrics\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/med.virginia.edu\/pediatrics\/wp-json\/wp\/v2\/pages\/1530","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/med.virginia.edu\/pediatrics\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/med.virginia.edu\/pediatrics\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/med.virginia.edu\/pediatrics\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/med.virginia.edu\/pediatrics\/wp-json\/wp\/v2\/comments?post=1530"}],"version-history":[{"count":3,"href":"https:\/\/med.virginia.edu\/pediatrics\/wp-json\/wp\/v2\/pages\/1530\/revisions"}],"predecessor-version":[{"id":1535,"href":"https:\/\/med.virginia.edu\/pediatrics\/wp-json\/wp\/v2\/pages\/1530\/revisions\/1535"}],"wp:attachment":[{"href":"https:\/\/med.virginia.edu\/pediatrics\/wp-json\/wp\/v2\/media?parent=1530"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/med.virginia.edu\/pediatrics\/wp-json\/wp\/v2\/tags?post=1530"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}