{"id":1250,"date":"2024-01-30T12:56:32","date_gmt":"2024-01-30T17:56:32","guid":{"rendered":"https:\/\/www.bumc.bu.edu\/gastroenterology\/?page_id=1250"},"modified":"2024-01-30T12:56:32","modified_gmt":"2024-01-30T17:56:32","slug":"epic-template-change-request-form","status":"publish","type":"page","link":"https:\/\/www.bumc.bu.edu\/gastroenterology\/epic-template-change-request-form\/","title":{"rendered":"Epic Template Change Request Form"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var 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class='gform_description'>Submit Clinic schedule Template Changes.<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_6'  action='\/gastroenterology\/wp-json\/wp\/v2\/pages\/1250' data-formid='6' >\n                        <div class='gform-body gform_body'><div id='gform_fields_6' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_6_1\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_6_1\"><label class='gfield_label gform-field-label' for='input_6_1' >Date<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_1' id='input_6_1' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_6_1_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_6_1_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_6_1' class='gform_hidden' value='https:\/\/www.bumc.bu.edu\/gastroenterology\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_6_27\"  class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_6_27\"><label class='gfield_label gform-field-label' for='input_6_27' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_27' id='input_6_27' type='text' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_6_3\"  class=\"gfield gfield--type-name field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_6_3\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Clinician Name<\/legend><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_6_3'>\n                            \n                            <span id='input_6_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.3' id='input_6_3_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_6_3_3' 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making changes to?<\/label><div class='ginput_container ginput_container_select'><select name='input_26' id='input_6_26' class='large gfield_select'     aria-invalid=\"false\" ><option value='Clinic' >Clinic<\/option><option value='Endoscopy' >Endoscopy<\/option><\/select><\/div><\/div><fieldset id=\"field_6_19\"  class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_6_19\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Which days of the week does this change apply to?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_6_19'><div class='gchoice gchoice_6_19_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.1' type='checkbox'  value='Monday'  id='choice_6_19_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_19_1' id='label_6_19_1' class='gform-field-label 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