Atlassian uses cookies to improve your browsing experience, perform analytics and research, and conduct advertising. Accept all cookies to indicate that you agree to our use of cookies on your device.
Atlassian uses cookies to improve your browsing experience, perform analytics and research, and conduct advertising. Accept all cookies to indicate that you agree to our use of cookies on your device. Atlassian cookies and tracking notice, (opens new window)
Welcome! You can raise a request for Pathology Client Services using the options provided.
Request Pad Order Form
Required fields are marked with an asterisk*
{"xsrfToken":"742a5c6f36d813693ee0e936088b83d5ce28e32b_lout","branding":{"id":"113","key":"pcs","name":"Pathology Client Services","portalBaseUrl":"/servicedesk/customer/portal/113"},"helpCenterBranding":{"logoUrl":"https://api.media.atlassian.com/file/c589657b-e628-47f2-b83c-0adbdf289e43/image/cdn?token=eyJhbGciOiJIUzI1NiJ9.eyJpc3MiOiIxYjJkY2ZkZC0yMjcwLTRjZjgtYTJmYy05ZTU4OTQ2MGYyOTYiLCJhY2Nlc3MiOnsidXJuOmZpbGVzdG9yZTpmaWxlOmM1ODk2NTdiLWU2MjgtNDdmMi1iODNjLTBhZGJkZjI4OWU0MyI6WyJyZWFkIl19LCJleHAiOjE3ODYyMDQ4MTgsIm5iZiI6MTc4NjIwNDIxOH0.7CJEeFBTdT0lxIj-300wVZ3mroMLzp0P4Yn7wqb88yY&client=1b2dcfdd-2270-4cf8-a2fc-9e589460f296&mode=fit","logoId":"c589657b-e628-47f2-b83c-0adbdf289e43","isLogoAvailable":true,"helpCenterTitle":"Welcome to the Jira Service Management Portal","sharedPortalName":"Portals","userInitialAnnouncementHeader":"","userInitialAnnouncementMessageWiki":"","translations":{"en-US":{"helpCenterTitle":"Welcome to the Jira Service Management Portal","sharedPortalName":"Portals","localeDisplayName":"English (United States)"}},"canEditAnnouncement":false,"siteDefaultLanguageTag":"en-US","userLanguageTag":"en-US","portalThemeColor":"#000000","helpCenterTitleColor":"#ffffff","bannerMediaApiUrl":"https://api.media.atlassian.com/file/97be3a0d-ca0b-481a-ba90-2e9e0b544392/image/cdn?token=eyJhbGciOiJIUzI1NiJ9.eyJpc3MiOiIxYjJkY2ZkZC0yMjcwLTRjZjgtYTJmYy05ZTU4OTQ2MGYyOTYiLCJhY2Nlc3MiOnsidXJuOmZpbGVzdG9yZTpmaWxlOjk3YmUzYTBkLWNhMGItNDgxYS1iYTkwLTJlOWUwYjU0NDM5MiI6WyJyZWFkIl19LCJleHAiOjE3ODYyMDQ4MTgsIm5iZiI6MTc4NjIwNDIxOH0.fOmVwqP4qBz4tAZ2ZNI5wtICgpFFzXkX5Drpk_YIPHw&client=1b2dcfdd-2270-4cf8-a2fc-9e589460f296&height=300&mode=fit","bannerMediaApiFileId":"97be3a0d-ca0b-481a-ba90-2e9e0b544392","useDefaultBanner":false,"isBannerAvailable":true,"topBarColor":"#FFFFFF","topBarTextColor":"#172B4D","hasTopBarBeenSplit":true},"portal":{"id":"113","key":"pcs","projectId":10218,"serviceDeskId":113,"name":"Pathology Client Services","description":"<p>Welcome! You can raise a request for Pathology Client Services using the options provided.</p>","portalBaseUrl":"/servicedesk/customer/portal/113","onlyPortal":false,"reqTypes":[{"id":"601","name":"Doctor Setup Form","descriptionHtml":"","callToAction":"Doctor Setup Form","introHtml":"","icon":10468,"iconUrl":"https://austinictemr.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10468","groups":[185],"key":""},{"id":"586","name":"Feedback Form","descriptionHtml":"","callToAction":"Feedback Form","introHtml":"","icon":10491,"iconUrl":"https://austinictemr.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10491","groups":[185],"key":""},{"id":"585","name":"Request Pad Order Form","descriptionHtml":"","callToAction":"Request Pad Order Form","introHtml":"","icon":10482,"iconUrl":"https://austinictemr.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10482","groups":[185],"key":""},{"id":"573","name":"Emailed request","descriptionHtml":"","callToAction":"Emailed request","introHtml":"<p>Request received from your email support channel.</p>","icon":10621,"iconUrl":"https://austinictemr.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10621","groups":[],"key":""}],"reqGroups":[{"id":185,"name":"Pathology Client Services"}],"orderMapping":{"185":[601,586,585]},"kbs":{"kbEnabled":false,"serviceDeskId":-1},"createPermission":true,"portalAnnouncement":{"portalId":113,"canEditAnnouncement":false,"canAdministerProject":false,"portalProjectKey":"PCS","userLanguageHeader":"","userLanguageMessageWiki":"","defaultLanguageHeader":"","defaultLanguageMessage":"","defaultLanguageDisplayName":"English (United States)","isUsingLanguageSupport":false,"translations":{}},"canViewCreateRequestForm":true,"isProjectSimplified":false,"mediaApiUploadInformation":{"token":"eyJhbGciOiJIUzI1NiJ9.eyJpc3MiOiIxYjJkY2ZkZC0yMjcwLTRjZjgtYTJmYy05ZTU4OTQ2MGYyOTYiLCJhY2Nlc3MiOnsidXJuOmZpbGVzdG9yZTpjb2xsZWN0aW9uOnVwbG9hZC11c2VyLWNvbGxlY3Rpb24tMTk2MzA4NTI1MSI6WyJyZWFkIiwiY3JlYXRlIiwidXBkYXRlIl0sInVybjpmaWxlc3RvcmU6dXBsb2FkOioiOlsicmVhZCIsImNyZWF0ZSIsInVwZGF0ZSJdLCJ1cm46ZmlsZXN0b3JlOmNodW5rOioiOlsicmVhZCIsImNyZWF0ZSJdfSwiZXhwIjoxNzg2MjA1NDE4LCJuYmYiOjE3ODYyMDQyMTgsImFub25JZCI6ImFub24tdXNlciIsImh0dHBzOi8vaWQuYXRsYXNzaWFuLmNvbS9hcHBBY2NyZWRpdGVkIjpmYWxzZX0.mUa_KQxQMfrxdrZdahlpRhD_XZ6D42zn0HHPFr_s2WU","targetCollection":"upload-user-collection-1963085251","endpointUrl":"https://api.media.atlassian.com","clientId":"1b2dcfdd-2270-4cf8-a2fc-9e589460f296","tokenDurationInMins":20}},"reqCreate":{"id":585,"projectId":10218,"issueType":{"id":"10200","name":"[System] Service request"},"form":{"name":"Request Pad Order Form","descriptionHtml":"","callToAction":"Request Pad Order Form","intro":"","instructions":"","icon":10482,"iconUrl":"https://austinictemr.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10482","key":""},"fields":[{"fieldType":"text","fieldId":"email","fieldConfigId":"","label":"Email confirmation to","description":"","descriptionHtml":"","required":true,"displayed":true,"presetValues":[]},{"fieldType":"attachment","jiraFieldType":"attachment","fieldId":"attachment","fieldConfigId":"","label":"Attachment","description":"","descriptionHtml":"","required":false,"displayed":true,"presetValues":[]},{"fieldType":"text","jiraFieldType":"summary","fieldId":"summary","fieldConfigId":"","label":"Summary","description":"","descriptionHtml":"","required":true,"displayed":false,"presetValues":["Request Pad Order - Austin Pathology"]}],"userOrganisations":[],"canBrowseUsers":false,"requestCreateBaseUrl":"/servicedesk/customer/portal/113/create/585","requestValidateBaseUrl":"/servicedesk/customer/portal/113/validate/585","calendarParams":{"firstDay":0,"date":"2026-08-09T01:50:18+1000","useISO8601WeekNumbers":false,"dateIfFormat":"%e/%b/%y","dateTimeIfFormat":"%e/%b/%y %I:%M %p","timeFormat":"12"},"kbs":{"kbEnabled":false,"serviceDeskId":-1},"canRaiseOnBehalf":false,"canSignupCustomers":false,"canCreateAttachments":true,"attachmentRequiredField":false,"hasGroups":true,"canSubmitWithEmailAddress":false,"showRecaptcha":true,"siteKey":"6LePXLkdAAAAAF4gCNalrL1IvZcqbNbZf_Zakudd","mediaApiUploadInformation":{"token":"eyJhbGciOiJIUzI1NiJ9.eyJpc3MiOiIxYjJkY2ZkZC0yMjcwLTRjZjgtYTJmYy05ZTU4OTQ2MGYyOTYiLCJhY2Nlc3MiOnsidXJuOmZpbGVzdG9yZTpjb2xsZWN0aW9uOnVwbG9hZC11c2VyLWNvbGxlY3Rpb24tMTk2MzA4NTI1MSI6WyJyZWFkIiwiY3JlYXRlIiwidXBkYXRlIl0sInVybjpmaWxlc3RvcmU6dXBsb2FkOioiOlsicmVhZCIsImNyZWF0ZSIsInVwZGF0ZSJdLCJ1cm46ZmlsZXN0b3JlOmNodW5rOioiOlsicmVhZCIsImNyZWF0ZSJdfSwiZXhwIjoxNzg2MjA1NDE4LCJuYmYiOjE3ODYyMDQyMTgsImFub25JZCI6ImFub24tdXNlciIsImh0dHBzOi8vaWQuYXRsYXNzaWFuLmNvbS9hcHBBY2NyZWRpdGVkIjpmYWxzZX0.mUa_KQxQMfrxdrZdahlpRhD_XZ6D42zn0HHPFr_s2WU","targetCollection":"upload-user-collection-1963085251","endpointUrl":"https://api.media.atlassian.com","clientId":"1b2dcfdd-2270-4cf8-a2fc-9e589460f296","tokenDurationInMins":20},"hasProformaForm":true,"proformaTemplateForm":{"id":6847914046425918,"updated":"2026-06-26T00:54:51.091426684Z","publish":{"jira":{"newIssueIssueTypeIds":[],"newIssueRequestTypeIds":[],"submitOnCreate":true,"validateOnCreate":true},"portal":{"portalRequestTypeIds":[585],"submitOnCreate":true,"validateOnCreate":true}},"design":{"settings":{"templateId":6847914046425918,"name":"Request Pad Order Form","submit":{"lock":false,"pdf":true},"templateFormUuid":"56d81a27-494e-46d1-8f93-2a2e20630c5d"},"layout":[{"version":1,"type":"doc","content":[{"type":"panel","attrs":{"panelType":"warning"},"content":[{"type":"paragraph","content":[{"type":"text","text":"Please see the overview of updates to the A5 request form, reflecting the recent changes to bulk billing requirements."}],"attrs":{"localId":"64bb6f6c-54da-4c40-ae4b-c0bb7853b39e"}},{"type":"paragraph","content":[{"type":"text","text":"https://www.austinpathology.org.au/resource/LhUBbjCpYR","marks":[{"type":"link","attrs":{"href":"https://www.austinpathology.org.au/resource/LhUBbjCpYR"}}]}],"attrs":{"localId":"a3270f7f-9206-465b-9766-6d5ffd1cc3c7"}}]},{"type":"panel","attrs":{"panelType":"note"},"content":[{"type":"paragraph","attrs":{"localId":"52dd57e1-838c-4303-9112-08f544be7589"},"content":[{"type":"text","text":"Please attach copy of current request form in the attachment field if available."}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":87},"layout":"default","localId":"a29bb115-062e-43f1-a1bc-8f77c7af9134"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":2},"layout":"default","localId":"89ec0c90-fa98-4a25-a29a-2d7052e7398d"}}]},{"version":1,"type":"doc","content":[{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":4},"layout":"default","localId":"f884f70b-ea6b-432b-9e62-f69b01e29986"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":5},"layout":"default","localId":"136c6a14-e3c9-426b-897d-356f9920cef9"}}]},{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":6},"layout":"default","localId":"935d2851-0992-4b65-968d-5050e022dcb0"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":7},"layout":"default","localId":"e89eb5d8-330d-45ce-ba2c-09bcf40bf199"}}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":8},"layout":"default","localId":"72bd23a7-ec9c-4b76-81ea-34d108f48b5a"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":9},"layout":"default","localId":"7ed9465d-dd69-405f-bf6c-4cf5b10f0b93"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":11},"layout":"default","localId":"eb5b6354-d18d-4550-b434-f9b50f9b43d6"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":152},"layout":"default","localId":"345e9fd4-1dc9-435f-b426-efbde189f171"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":153},"layout":"default","localId":"7a25fee3-b5db-4c21-a91b-ab3bdca3b466"}}]},{"version":1,"type":"doc","content":[{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":13},"layout":"default","localId":"f3b4e3f3-db68-4a16-9ca4-007793ec2339"}}]},{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":14},"layout":"default","localId":"fdd27d1e-4e4f-427b-a05f-826fd56960d1"}}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":15},"layout":"default","localId":"0af3d396-85f8-4027-bf02-c8302b648a9a"}}]},{"version":1,"type":"doc","content":[{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":173},"layout":"default","localId":"4b401a42-73f2-4e09-b366-1000b8af7891"}}]},{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":174},"layout":"default","localId":"6afc10f5-c346-4761-ac28-b4022f4bc314"}}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":177},"layout":"default","localId":"78ae0b82-2ce6-4a5b-8935-a336bd8e3532"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":58},"layout":"default","localId":"7cb3da21-61cc-4efe-9521-c685ac9e6401"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":55},"layout":"default","localId":"5b1e551e-fd96-4f56-a2a9-5517f215df9d"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":19},"layout":"default","localId":"f10b365e-f064-4175-a2dd-44e8c679de03"}}]},{"version":1,"type":"doc","content":[{"type":"panel","attrs":{"panelType":"note"},"content":[{"type":"paragraph","attrs":{"localId":"5eb6ca7f-bf5f-4084-b624-1bd71fa38bcb"},"content":[{"type":"text","text":"“Please attach copy of current request form in the attachment field if available”"}]}]}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":124},"layout":"default","localId":"f44c52c2-e39d-4d15-b16d-73bc96e72b2a"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":134},"layout":"default","localId":"6b920a10-3167-49a5-b4ac-28f424498335"}}]},{"version":1,"type":"doc","content":[{"type":"panel","attrs":{"panelType":"note"},"content":[{"type":"paragraph","attrs":{"localId":"f2814a25-f2ad-4295-a264-7c9e8b20f008"},"content":[{"type":"text","text":"“Please attach copy of current request form in the attachment field if available”"}]}]}]},{"version":1,"type":"doc","content":[{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":127},"layout":"default","localId":"256b12e9-89ff-4148-89cc-1de3c9eb0b37"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":128},"layout":"default","localId":"6f3d0cc9-56c7-4684-b2b1-bbe064ff8abe"}}]},{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":129},"layout":"default","localId":"6692649f-1ed0-44b3-8ed9-1fc041bf075e"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":130},"layout":"default","localId":"41a9d92d-3b33-486a-9dce-dd14b7334fb1"}}]}]}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":82},"layout":"default","localId":"af39d816-98e5-4b12-90c1-f415d632dcf1"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":75},"layout":"default","localId":"dba0c88d-2c2a-4949-a573-2e4de6d5bfa8"}}]},{"version":1,"type":"doc","content":[{"type":"panel","attrs":{"panelType":"note"},"content":[{"type":"paragraph","attrs":{"localId":"fbc7e035-8da0-45f1-8b05-40b44523a51c"},"content":[{"type":"text","text":"“Please attach copy of current request form in the attachment field if available”"}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":92},"layout":"default","localId":"1e2bd56b-67be-4455-8c74-33992b463188"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":76},"layout":"default","localId":"a351acb4-4ee7-44ca-bd36-8f52fc6133f4"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":111},"layout":"default","localId":"92d293e3-ef76-4e8f-90e5-7425e0266d23"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":94},"layout":"default","localId":"dff9b721-5167-46aa-b5bf-2a28ad0370de"}},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":66},"layout":"default","localId":"5a0b83a0-57c5-4059-b906-77a561800c40"}}]},{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":67},"layout":"default","localId":"9a3b3f1f-1899-403d-b956-f5f973c03263"}}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":65},"layout":"default","localId":"ee0ab65d-3343-44b1-b49c-4a199b29292b"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":97},"layout":"default","localId":"1c3599dc-accd-4b48-9c82-2aead82e387f"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":100},"layout":"default","localId":"6435b82d-de19-4cdf-99cd-2373f55560f1"}}]},{"version":1,"type":"doc","content":[{"type":"panel","attrs":{"panelType":"note"},"content":[{"type":"paragraph","attrs":{"localId":"b92aa5d8-1620-4777-89f4-3895f1b78aee"},"content":[{"type":"text","text":"“Please attach copy of current request form in the attachment field if available”"}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":104},"layout":"default","localId":"cc2b53d9-ae1c-4298-bd08-5d790b774fbe"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":106},"layout":"default","localId":"29895100-b781-48bd-8c62-f49bd5d8aee5"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":112},"layout":"default","localId":"c8c411a7-f3df-42c7-9f21-2243722354c5"}}]},{"version":1,"type":"doc","content":[{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":115},"layout":"default","localId":"344a9fdb-c310-4204-b085-9cd872743207"}}]},{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":116},"layout":"default","localId":"1011c44d-6aa6-4f96-a1d2-767d563e259c"}}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":118},"layout":"default","localId":"02ab0800-9d38-45dd-b7ac-6c2e1e409078"}}]},{"version":1,"type":"doc","content":[{"type":"paragraph","attrs":{"localId":"b407c892-059b-4dbf-a667-ed5f610fb66e"},"content":[{"type":"text","text":"Form Details","marks":[{"type":"strong"}]}]},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":27},"layout":"default","localId":"5eb827ae-e96e-418b-9b73-206c96d8c926"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":28},"layout":"default","localId":"55cf13b7-9a30-4a2e-bfa5-47b85ac2e039"}}]},{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":29},"layout":"default","localId":"ca3cec56-0079-46ba-a671-e91306d190a3"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":30},"layout":"default","localId":"28015a67-8182-4080-8fa6-29598f2c6c30"}}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":31},"layout":"default","localId":"ad83ca97-637e-49fb-9d9a-a7688a27a942"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":32},"layout":"default","localId":"95703562-6f94-4296-902b-febb7ff9f696"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":33},"layout":"default","localId":"225db650-d9bd-4e2a-add1-b4b90d84bc3d"}}]},{"version":1,"type":"doc","content":[{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":35},"layout":"default","localId":"6ddc292f-1161-40b4-b5fb-bb5da40f5e13"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":36},"layout":"default","localId":"09324529-968a-4eae-a7f0-5cab9ab866cb"}}]},{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":37},"layout":"default","localId":"ae4825fb-1b1f-4b79-a106-accf6ee04c91"}},{"type":"paragraph","content":[]}]}]},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":38},"layout":"default","localId":"c95d2e52-9c99-4c36-8c00-108d3a9f87bd"}}]},{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":39},"layout":"default","localId":"69f2e2b7-30f2-4048-98d3-05ca838335c3"}}]}]}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":140},"layout":"default","localId":"d3ea9593-298b-43b9-952d-153c893464c1"}}]},{"version":1,"type":"doc","content":[{"type":"panel","attrs":{"panelType":"warning"},"content":[{"type":"paragraph","attrs":{"localId":"6ea8562a-68f8-4b2b-b823-16f537c5f793"},"content":[{"type":"text","text":"This form is for Bulk Orders only (1 Box/40 pads minimum). For small orders please choose A5 Personalised. "}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":144},"layout":"default","localId":"a1bd3e10-8f49-42d8-b837-9b3374b65df2"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":146},"layout":"default","localId":"f0ca56a3-f1ed-4b2c-9c92-911581f3282c"}},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":148},"layout":"default","localId":"7443f9f9-3b93-4ec0-a84b-de7f258e5e89"}}]},{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":149},"layout":"default","localId":"24c3aebd-aa82-4822-9ce8-eecd649a19f4"}}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":150},"layout":"default","localId":"b4b6c626-ebc5-42a0-a2a8-855aec9a4e55"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":145},"layout":"default","localId":"f0473373-59df-49a5-b312-dc1ef632c150"}}]},{"version":1,"type":"doc","content":[{"type":"panel","attrs":{"panelType":"warning"},"content":[{"type":"paragraph","attrs":{"localId":"432d5aec-8166-497b-943d-76167564edc2"},"content":[{"type":"text","text":"This form is for Bendigo Bulk Orders only (1 Box/40 pads minimum). For small orders please choose A5 Personalised. "}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":159},"layout":"default","localId":"3c3a863f-283e-4b57-b936-565015543822"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":161},"layout":"default","localId":"bd21cf13-9caf-4946-965d-94d9b7d3fc7e"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":166},"layout":"default","localId":"515ce280-7a5d-4d05-9ef3-91b432d49f66"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":164},"layout":"default","localId":"02f4e249-f49c-472d-96ca-3bc5c418328f"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":165},"layout":"default","localId":"e5a08098-6c88-47c4-ad62-2828bf072749"}}]}],"conditions":{"51":{"i":{"co":{"cIds":{"2":["2","8","9","10","7","4","13"]}},"operator":"OR","groups":[{"operator":"AND","checks":[{"fieldId":"2","type":"SOME_OF","constraint":["2","8","9","10","7","4","13"]}]}]},"o":{"sIds":["5"]},"t":"sh"},"135":{"i":{"co":{"cIds":{"134":["1"]}}},"o":{"sIds":["13"]},"t":"sh"},"155":{"i":{"co":{"cIds":{"2":["4"]}}},"o":{"sIds":["4"]},"t":"sh"},"79":{"i":{"co":{"cIds":{"75":["2"]}}},"o":{"sIds":["19"]},"t":"sh"},"59":{"i":{"co":{"cIds":{"2":["9"]}}},"o":{"sIds":["15"]},"t":"sh"},"54":{"i":{"co":{"cIds":{"58":["1"]}}},"o":{"sIds":["8"]},"t":"sh"},"108":{"i":{"co":{"cIds":{"2":["10"]}}},"o":{"sIds":["22"]},"t":"sh"},"49":{"i":{"co":{"cIds":{"2":["4","8","2","13"]}},"operator":"OR","groups":[{"operator":"AND","checks":[{"fieldId":"2","type":"SOME_OF","constraint":["4","8","2","13"]}]}]},"o":{"sIds":["9"]},"t":"sh"},"53":{"i":{"co":{"cIds":{"2":["3"]}}},"o":{"sIds":["1"]},"t":"sh"},"156":{"i":{"co":{"cIds":{"2":["12"]}},"operator":"OR","groups":[{"operator":"AND","checks":[{"fieldId":"2","type":"SOME_OF","constraint":["12"]}]}]},"o":{"sIds":["29"]},"t":"sh"},"167":{"i":{"co":{"cIds":{"2":["12"]}},"operator":"OR","groups":[{"operator":"AND","checks":[{"fieldId":"2","type":"SOME_OF","constraint":["12"]}]}]},"o":{"sIds":["6"]},"t":"sh"},"125":{"i":{"co":{"cIds":{"124":["2"]}}},"o":{"sIds":["12"]},"t":"sh"},"119":{"i":{"co":{"cIds":{"100":["2"]}}},"o":{"sIds":["24"]},"t":"sh"},"98":{"i":{"co":{"cIds":{"2":["10"]}}},"o":{"sIds":["20"]},"t":"sh"},"113":{"i":{"co":{"cIds":{"104":["1"]}}},"o":{"sIds":["23"]},"t":"sh"},"120":{"i":{"co":{"cIds":{"2":["2","4","8","13"]}},"operator":"OR","groups":[{"operator":"AND","checks":[{"fieldId":"2","type":"SOME_OF","constraint":["2","4","8","13"]}]}]},"o":{"sIds":["25"]},"t":"sh"},"84":{"i":{"co":{"cIds":{"75":["1"]}}},"o":{"sIds":["16"]},"t":"sh"},"78":{"i":{"co":{"cIds":{"92":["1"]}}},"o":{"sIds":["18"]},"t":"sh"},"90":{"i":{"co":{"cIds":{"19":["1"]}}},"o":{"sIds":["10"]},"t":"sh"},"141":{"i":{"co":{"cIds":{"2":["11"]}}},"o":{"sIds":["28"]},"t":"sh"},"163":{"i":{"co":{"cIds":{"159":["2"]}},"operator":"OR","groups":[{"operator":"AND","checks":[{"fieldId":"159","type":"SOME_OF","constraint":["2"]}]}]},"o":{"sIds":["31"]},"t":"sh"},"123":{"i":{"co":{"cIds":{"2":["7"]}}},"o":{"sIds":["11"]},"t":"sh"},"107":{"i":{"co":{"cIds":{"100":["1"]}}},"o":{"sIds":["21"]},"t":"sh"},"46":{"i":{"co":{"cIds":{"124":["1","2"]}}},"o":{"sIds":["27"]},"t":"sh"},"80":{"i":{"co":{"cIds":{"2":["2","7","4","8","13"]}},"operator":"OR","groups":[{"operator":"AND","checks":[{"fieldId":"2","type":"SOME_OF","constraint":["2","7","4","8","13"]}]}]},"o":{"sIds":["7"]},"t":"sh"},"137":{"i":{"co":{"cIds":{"134":["1","2"]}}},"o":{"sIds":["14"]},"t":"sh"},"47":{"i":{"co":{"cIds":{"33":["1"]}}},"o":{"sIds":["26"]},"t":"sh"},"122":{"i":{"co":{"cIds":{"2":["7"]}}},"o":{"sIds":["3"]},"t":"sh"},"162":{"i":{"co":{"cIds":{"159":["1"]}},"operator":"OR","groups":[{"operator":"AND","checks":[{"fieldId":"159","type":"SOME_OF","constraint":["1"]}]}]},"o":{"sIds":["30"]},"t":"sh"},"52":{"i":{"co":{"cIds":{"2":["2","9","10","8","13"]}},"operator":"OR","groups":[{"operator":"AND","checks":[{"fieldId":"2","type":"SOME_OF","constraint":["2","9","10","8","13"]}]}]},"o":{"sIds":["2"]},"t":"sh"},"85":{"i":{"co":{"cIds":{"2":["9"]}}},"o":{"sIds":["17"]},"t":"sh"}},"sections":{"12":{"name":"Blood Bank 3","conditions":["125"]},"8":{"name":"A5 Personalised Part 3","conditions":["54"]},"4":{"name":"A5 Cervical","conditions":["155"]},"22":{"name":"SCOPE 3","conditions":["108"]},"26":{"name":"A5 Personalised Part 7","conditions":["47"]},"13":{"name":"Blood Bank 4","conditions":["135"]},"5":{"name":"A5 Personalised ALL ","conditions":["51"]},"10":{"name":"A5 Personalised Part 5","conditions":["90"]},"21":{"name":"SCOPE 2","conditions":["107"]},"31":{"name":"A5 BEN Blood Bank","conditions":["163"]},"2":{"name":"A5 Personalised Part","conditions":["52"]},"18":{"name":"INFCON 4","conditions":["78"]},"29":{"name":"Bendigo Bulk","conditions":["156"]},"3":{"name":"Blood Bank","conditions":["122"]},"28":{"name":"Mercy","conditions":["141"]},"19":{"name":"New INFCON","conditions":["79"]},"23":{"name":"SCOPE 4","conditions":["113"]},"15":{"name":"INFCON","conditions":["59"]},"11":{"name":"Blood Bank 2","conditions":["123"]},"9":{"name":"A5 Personalised Part 4","conditions":["49"]},"24":{"name":"SCOPE 5","conditions":["119"]},"16":{"name":"INFCON 2","conditions":["84"]},"6":{"name":"A5 BEN Bulk","conditions":["167"]},"1":{"name":"A4 PS","conditions":["53"]},"17":{"name":"INFCON 3","conditions":["85"]},"25":{"name":"A5 Personalised Part 6","conditions":["120"]},"14":{"name":"Blood Bank 5","conditions":["137"]},"20":{"name":"SCOPE","conditions":["98"]},"27":{"name":"Blood Bank 4","conditions":["46"]},"30":{"name":"A5 HCF BEN","conditions":["162"]},"7":{"name":"A5 Personalised Part 2","conditions":["80"]}},"questions":{"66":{"type":"ts","label":"Infection Control Contact Number","description":"For urgent result notification","validation":{"rq":true},"choices":[],"questionKey":""},"33":{"type":"cs","label":"Do you want to add a copy to?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"55":{"type":"ts","label":"Ward","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"106":{"type":"cs","label":"Type of Scope Form","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Washing and Brushing ","other":false},{"id":"2","label":"Filter (Re-processor Filter)","other":false}],"questionKey":""},"118":{"type":"rt","label":"Special Instructions","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"150":{"type":"cs","label":"Type of Form","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Mercy Blank Form (HCF = MHW)","other":false},{"id":"2","label":"Dr A Shub - Emergency Department","other":false},{"id":"3","label":"Dr A Shub - Blood Bank","other":false},{"id":"4","label":"Dr M Rasmussen","other":false},{"id":"5","label":"Neonatal - Blue","other":false},{"id":"6","label":"Neonatal - Green","other":false}],"questionKey":""},"67":{"type":"ts","label":"After Hours Number","description":"If different from regular number","validation":{"rq":false},"choices":[],"questionKey":""},"153":{"type":"cd","label":"Number of Pads Required","description":"1 pad = 100 forms","validation":{"rq":true},"choices":[{"id":"3","label":"8","other":false},{"id":"4","label":"12","other":false},{"id":"6","label":"16","other":false},{"id":"10","label":"24","other":false}],"questionKey":""},"124":{"type":"cs","label":"Type of Form","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Blank","other":false},{"id":"2","label":"Personalised","other":false}],"questionKey":""},"8":{"type":"cs","label":"Labels on forms?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"164":{"type":"cs","label":"Number of Pads Required","description":"1 Pad = 50 requests","validation":{"rq":true},"choices":[{"id":"1","label":"80","other":false},{"id":"2","label":"120","other":false}],"questionKey":""},"19":{"type":"cs","label":"Is this a reorder of an existing form?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"100":{"type":"cs","label":"Is this a reorder of an existing form?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"128":{"type":"ts","label":"HCF","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"4":{"type":"no","label":"Number of Pads Required","description":"1 pad - 100 forms","validation":{"rq":true,"mnn":1,"mxn":100,"wh":true},"choices":[],"questionKey":""},"15":{"type":"tl","label":"Delivery Address","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"9":{"type":"rt","label":"Special Instructions","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"11":{"type":"cd","label":"Number of Pads Required","description":"1 pad = 100 forms","validation":{"rq":true},"choices":[{"id":"11","label":"Digital Request Form","other":false},{"id":"1","label":"2","other":false},{"id":"2","label":"4","other":false},{"id":"3","label":"8","other":false},{"id":"4","label":"12","other":false},{"id":"6","label":"20","other":false},{"id":"10","label":"40","other":false}],"questionKey":""},"104":{"type":"cs","label":"Any changes to the existing form?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"134":{"type":"cs","label":"Is this a reorder of an existing form?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"174":{"type":"ts","label":"Department/Ward Name","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"37":{"type":"tl","label":"Provider Number","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"166":{"type":"rt","label":"Special Instructions","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"13":{"type":"ts","label":"HCF/GP Practice Name","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"177":{"type":"tl","label":"Delivery Address","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"94":{"type":"ts","label":"Infection Control Coordinator Name","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"35":{"type":"tl","label":"Name","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"152":{"type":"cd","label":"Number of Pads Required","description":"1 pad = 50 forms","validation":{"rq":true},"choices":[{"id":"7","label":"Digital Request Form","other":false},{"id":"1","label":"2","other":false},{"id":"2","label":"4","other":false},{"id":"3","label":"8","other":false},{"id":"4","label":"12","other":false},{"id":"5","label":"20","other":false},{"id":"6","label":"40","other":false}],"questionKey":""},"5":{"type":"tl","label":"HCF/GP Practice","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"112":{"type":"rt","label":"Required Changes","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"159":{"type":"cs","label":"Type of Form","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"A5 HCF BEN","other":false},{"id":"2","label":"A5 BEN Blood Bank","other":false}],"questionKey":""},"144":{"type":"ts","label":"Number of Boxes","description":"1 Box = 40 Pads","validation":{"rq":true},"choices":[],"questionKey":""},"87":{"type":"tl","label":"Contact Name","description":"Please enter your full name","validation":{"rq":true},"choices":[],"questionKey":""},"116":{"type":"ts","label":"Phone Number","description":"For urgent result notification","validation":{"rq":true},"choices":[],"questionKey":""},"76":{"type":"cs","label":"Type of Infection Control form","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Healthcare Worker Immunity Check ","other":false},{"id":"2","label":"Exposure Recipient ","other":false},{"id":"3","label":"Exposure Source","other":false},{"id":"0","label":"Other...","other":true}],"questionKey":""},"148":{"type":"ts","label":"Ward","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"127":{"type":"tl","label":"Doctor Name","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"65":{"type":"rt","label":"Special Instructions ","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"32":{"type":"cd","label":"Type of Patients","description":"","validation":{"rq":false},"choices":[{"id":"1","label":"Inpatients","other":false},{"id":"2","label":"Outpatients","other":false},{"id":"3","label":"Both","other":false}],"questionKey":""},"82":{"type":"ts","label":"Ward","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"6":{"type":"ts","label":"Contact Number:","description":" ","validation":{"rq":true},"choices":[],"questionKey":""},"36":{"type":"tl","label":"Location","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"39":{"type":"ts","label":"Healthlink EDI","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"140":{"type":"rt","label":"Special Instructions","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"173":{"type":"ts","label":"Contact Number","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"14":{"type":"ts","label":"Contact Number:","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"111":{"type":"rt","label":"Required Changes","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"31":{"type":"rt","label":"Special Instructions","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"58":{"type":"cs","label":"Are you at a hospital site?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"145":{"type":"rt","label":"Special Instructions","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"75":{"type":"cs","label":"Is this a reorder of an existing form?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"115":{"type":"ts","label":"Contact Name","description":"Key scope testing contact","validation":{"rq":true},"choices":[],"questionKey":""},"149":{"type":"ts","label":"Contact Number","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"27":{"type":"tl","label":"Doctor Name","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"2":{"type":"cs","label":"Type of Request Pad","description":"","validation":{"rq":true},"choices":[{"id":"3","label":"A4 Practice Software","other":false},{"id":"2","label":"A5 Personalised","other":false},{"id":"7","label":"A5 Blood Bank","other":false},{"id":"4","label":"A5 Cervical","other":false},{"id":"8","label":"A5 Cytology","other":false},{"id":"13","label":"A5 Endoscopy","other":false},{"id":"9","label":"A5 Infection Control","other":false},{"id":"10","label":"A5 Scope","other":false},{"id":"11","label":"A5 Mercy - Bulk Order","other":false},{"id":"12","label":"A5 Bendigo - Bulk Order","other":false}],"questionKey":""},"38":{"type":"no","label":"Fax","description":"","validation":{"rq":false,"wh":false},"choices":[],"questionKey":""},"165":{"type":"rt","label":"Special Instructions","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"92":{"type":"cs","label":"Any changes to the existing form?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"30":{"type":"ts","label":"Ward","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"7":{"type":"tl","label":"Delivery Address","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"97":{"type":"ts","label":"Ward","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"130":{"type":"ts","label":"Ward","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"129":{"type":"tl","label":"Provider Number(s)","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"29":{"type":"tl","label":"Provider Number(s)","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"28":{"type":"ts","label":"HCF","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"161":{"type":"ts","label":"Number of Boxes","description":"1 Box = 40 Pads","validation":{"rq":true},"choices":[],"questionKey":""},"146":{"type":"tl","label":"Delivery Address","description":"","validation":{"rq":true},"choices":[],"questionKey":""}}},"uuid":"56d81a27-494e-46d1-8f93-2a2e20630c5d"},"proforma":{"formExists":true,"formValid":true,"formTemplateData":{"id":6847914046425918,"updated":"2026-06-26T00:54:51.091426684Z","publish":{"jira":{"newIssueIssueTypeIds":[],"newIssueRequestTypeIds":[],"submitOnCreate":true,"validateOnCreate":true},"portal":{"portalRequestTypeIds":[585],"submitOnCreate":true,"validateOnCreate":true}},"design":{"settings":{"templateId":6847914046425918,"name":"Request Pad Order Form","submit":{"lock":false,"pdf":true},"templateFormUuid":"56d81a27-494e-46d1-8f93-2a2e20630c5d"},"layout":[{"version":1,"type":"doc","content":[{"type":"panel","attrs":{"panelType":"warning"},"content":[{"type":"paragraph","content":[{"type":"text","text":"Please see the overview of updates to the A5 request form, reflecting the recent changes to bulk billing requirements."}],"attrs":{"localId":"64bb6f6c-54da-4c40-ae4b-c0bb7853b39e"}},{"type":"paragraph","content":[{"type":"text","text":"https://www.austinpathology.org.au/resource/LhUBbjCpYR","marks":[{"type":"link","attrs":{"href":"https://www.austinpathology.org.au/resource/LhUBbjCpYR"}}]}],"attrs":{"localId":"a3270f7f-9206-465b-9766-6d5ffd1cc3c7"}}]},{"type":"panel","attrs":{"panelType":"note"},"content":[{"type":"paragraph","attrs":{"localId":"52dd57e1-838c-4303-9112-08f544be7589"},"content":[{"type":"text","text":"Please attach copy of current request form in the attachment field if available."}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":87},"layout":"default","localId":"a29bb115-062e-43f1-a1bc-8f77c7af9134"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":2},"layout":"default","localId":"89ec0c90-fa98-4a25-a29a-2d7052e7398d"}}]},{"version":1,"type":"doc","content":[{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":4},"layout":"default","localId":"f884f70b-ea6b-432b-9e62-f69b01e29986"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":5},"layout":"default","localId":"136c6a14-e3c9-426b-897d-356f9920cef9"}}]},{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":6},"layout":"default","localId":"935d2851-0992-4b65-968d-5050e022dcb0"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":7},"layout":"default","localId":"e89eb5d8-330d-45ce-ba2c-09bcf40bf199"}}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":8},"layout":"default","localId":"72bd23a7-ec9c-4b76-81ea-34d108f48b5a"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":9},"layout":"default","localId":"7ed9465d-dd69-405f-bf6c-4cf5b10f0b93"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":11},"layout":"default","localId":"eb5b6354-d18d-4550-b434-f9b50f9b43d6"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":152},"layout":"default","localId":"345e9fd4-1dc9-435f-b426-efbde189f171"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":153},"layout":"default","localId":"7a25fee3-b5db-4c21-a91b-ab3bdca3b466"}}]},{"version":1,"type":"doc","content":[{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":13},"layout":"default","localId":"f3b4e3f3-db68-4a16-9ca4-007793ec2339"}}]},{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":14},"layout":"default","localId":"fdd27d1e-4e4f-427b-a05f-826fd56960d1"}}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":15},"layout":"default","localId":"0af3d396-85f8-4027-bf02-c8302b648a9a"}}]},{"version":1,"type":"doc","content":[{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":173},"layout":"default","localId":"4b401a42-73f2-4e09-b366-1000b8af7891"}}]},{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":174},"layout":"default","localId":"6afc10f5-c346-4761-ac28-b4022f4bc314"}}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":177},"layout":"default","localId":"78ae0b82-2ce6-4a5b-8935-a336bd8e3532"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":58},"layout":"default","localId":"7cb3da21-61cc-4efe-9521-c685ac9e6401"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":55},"layout":"default","localId":"5b1e551e-fd96-4f56-a2a9-5517f215df9d"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":19},"layout":"default","localId":"f10b365e-f064-4175-a2dd-44e8c679de03"}}]},{"version":1,"type":"doc","content":[{"type":"panel","attrs":{"panelType":"note"},"content":[{"type":"paragraph","attrs":{"localId":"5eb6ca7f-bf5f-4084-b624-1bd71fa38bcb"},"content":[{"type":"text","text":"“Please attach copy of current request form in the attachment field if available”"}]}]}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":124},"layout":"default","localId":"f44c52c2-e39d-4d15-b16d-73bc96e72b2a"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":134},"layout":"default","localId":"6b920a10-3167-49a5-b4ac-28f424498335"}}]},{"version":1,"type":"doc","content":[{"type":"panel","attrs":{"panelType":"note"},"content":[{"type":"paragraph","attrs":{"localId":"f2814a25-f2ad-4295-a264-7c9e8b20f008"},"content":[{"type":"text","text":"“Please attach copy of current request form in the attachment field if available”"}]}]}]},{"version":1,"type":"doc","content":[{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":127},"layout":"default","localId":"256b12e9-89ff-4148-89cc-1de3c9eb0b37"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":128},"layout":"default","localId":"6f3d0cc9-56c7-4684-b2b1-bbe064ff8abe"}}]},{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":129},"layout":"default","localId":"6692649f-1ed0-44b3-8ed9-1fc041bf075e"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":130},"layout":"default","localId":"41a9d92d-3b33-486a-9dce-dd14b7334fb1"}}]}]}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":82},"layout":"default","localId":"af39d816-98e5-4b12-90c1-f415d632dcf1"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":75},"layout":"default","localId":"dba0c88d-2c2a-4949-a573-2e4de6d5bfa8"}}]},{"version":1,"type":"doc","content":[{"type":"panel","attrs":{"panelType":"note"},"content":[{"type":"paragraph","attrs":{"localId":"fbc7e035-8da0-45f1-8b05-40b44523a51c"},"content":[{"type":"text","text":"“Please attach copy of current request form in the attachment field if available”"}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":92},"layout":"default","localId":"1e2bd56b-67be-4455-8c74-33992b463188"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":76},"layout":"default","localId":"a351acb4-4ee7-44ca-bd36-8f52fc6133f4"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":111},"layout":"default","localId":"92d293e3-ef76-4e8f-90e5-7425e0266d23"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":94},"layout":"default","localId":"dff9b721-5167-46aa-b5bf-2a28ad0370de"}},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":66},"layout":"default","localId":"5a0b83a0-57c5-4059-b906-77a561800c40"}}]},{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":67},"layout":"default","localId":"9a3b3f1f-1899-403d-b956-f5f973c03263"}}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":65},"layout":"default","localId":"ee0ab65d-3343-44b1-b49c-4a199b29292b"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":97},"layout":"default","localId":"1c3599dc-accd-4b48-9c82-2aead82e387f"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":100},"layout":"default","localId":"6435b82d-de19-4cdf-99cd-2373f55560f1"}}]},{"version":1,"type":"doc","content":[{"type":"panel","attrs":{"panelType":"note"},"content":[{"type":"paragraph","attrs":{"localId":"b92aa5d8-1620-4777-89f4-3895f1b78aee"},"content":[{"type":"text","text":"“Please attach copy of current request form in the attachment field if available”"}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":104},"layout":"default","localId":"cc2b53d9-ae1c-4298-bd08-5d790b774fbe"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":106},"layout":"default","localId":"29895100-b781-48bd-8c62-f49bd5d8aee5"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":112},"layout":"default","localId":"c8c411a7-f3df-42c7-9f21-2243722354c5"}}]},{"version":1,"type":"doc","content":[{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":115},"layout":"default","localId":"344a9fdb-c310-4204-b085-9cd872743207"}}]},{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":116},"layout":"default","localId":"1011c44d-6aa6-4f96-a1d2-767d563e259c"}}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":118},"layout":"default","localId":"02ab0800-9d38-45dd-b7ac-6c2e1e409078"}}]},{"version":1,"type":"doc","content":[{"type":"paragraph","attrs":{"localId":"b407c892-059b-4dbf-a667-ed5f610fb66e"},"content":[{"type":"text","text":"Form Details","marks":[{"type":"strong"}]}]},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":27},"layout":"default","localId":"5eb827ae-e96e-418b-9b73-206c96d8c926"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":28},"layout":"default","localId":"55cf13b7-9a30-4a2e-bfa5-47b85ac2e039"}}]},{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":29},"layout":"default","localId":"ca3cec56-0079-46ba-a671-e91306d190a3"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":30},"layout":"default","localId":"28015a67-8182-4080-8fa6-29598f2c6c30"}}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":31},"layout":"default","localId":"ad83ca97-637e-49fb-9d9a-a7688a27a942"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":32},"layout":"default","localId":"95703562-6f94-4296-902b-febb7ff9f696"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":33},"layout":"default","localId":"225db650-d9bd-4e2a-add1-b4b90d84bc3d"}}]},{"version":1,"type":"doc","content":[{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":35},"layout":"default","localId":"6ddc292f-1161-40b4-b5fb-bb5da40f5e13"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":36},"layout":"default","localId":"09324529-968a-4eae-a7f0-5cab9ab866cb"}}]},{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":37},"layout":"default","localId":"ae4825fb-1b1f-4b79-a106-accf6ee04c91"}},{"type":"paragraph","content":[]}]}]},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":38},"layout":"default","localId":"c95d2e52-9c99-4c36-8c00-108d3a9f87bd"}}]},{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":39},"layout":"default","localId":"69f2e2b7-30f2-4048-98d3-05ca838335c3"}}]}]}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":140},"layout":"default","localId":"d3ea9593-298b-43b9-952d-153c893464c1"}}]},{"version":1,"type":"doc","content":[{"type":"panel","attrs":{"panelType":"warning"},"content":[{"type":"paragraph","attrs":{"localId":"6ea8562a-68f8-4b2b-b823-16f537c5f793"},"content":[{"type":"text","text":"This form is for Bulk Orders only (1 Box/40 pads minimum). For small orders please choose A5 Personalised. "}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":144},"layout":"default","localId":"a1bd3e10-8f49-42d8-b837-9b3374b65df2"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":146},"layout":"default","localId":"f0ca56a3-f1ed-4b2c-9c92-911581f3282c"}},{"type":"layoutSection","content":[{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":148},"layout":"default","localId":"7443f9f9-3b93-4ec0-a84b-de7f258e5e89"}}]},{"type":"layoutColumn","attrs":{"width":50},"content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":149},"layout":"default","localId":"24c3aebd-aa82-4822-9ce8-eecd649a19f4"}}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":150},"layout":"default","localId":"b4b6c626-ebc5-42a0-a2a8-855aec9a4e55"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":145},"layout":"default","localId":"f0473373-59df-49a5-b312-dc1ef632c150"}}]},{"version":1,"type":"doc","content":[{"type":"panel","attrs":{"panelType":"warning"},"content":[{"type":"paragraph","attrs":{"localId":"432d5aec-8166-497b-943d-76167564edc2"},"content":[{"type":"text","text":"This form is for Bendigo Bulk Orders only (1 Box/40 pads minimum). For small orders please choose A5 Personalised. "}]}]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":159},"layout":"default","localId":"3c3a863f-283e-4b57-b936-565015543822"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":161},"layout":"default","localId":"bd21cf13-9caf-4946-965d-94d9b7d3fc7e"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":166},"layout":"default","localId":"515ce280-7a5d-4d05-9ef3-91b432d49f66"}}]},{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":164},"layout":"default","localId":"02f4e249-f49c-472d-96ca-3bc5c418328f"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":165},"layout":"default","localId":"e5a08098-6c88-47c4-ad62-2828bf072749"}}]}],"conditions":{"51":{"i":{"co":{"cIds":{"2":["2","8","9","10","7","4","13"]}},"operator":"OR","groups":[{"operator":"AND","checks":[{"fieldId":"2","type":"SOME_OF","constraint":["2","8","9","10","7","4","13"]}]}]},"o":{"sIds":["5"]},"t":"sh"},"135":{"i":{"co":{"cIds":{"134":["1"]}}},"o":{"sIds":["13"]},"t":"sh"},"155":{"i":{"co":{"cIds":{"2":["4"]}}},"o":{"sIds":["4"]},"t":"sh"},"79":{"i":{"co":{"cIds":{"75":["2"]}}},"o":{"sIds":["19"]},"t":"sh"},"59":{"i":{"co":{"cIds":{"2":["9"]}}},"o":{"sIds":["15"]},"t":"sh"},"54":{"i":{"co":{"cIds":{"58":["1"]}}},"o":{"sIds":["8"]},"t":"sh"},"108":{"i":{"co":{"cIds":{"2":["10"]}}},"o":{"sIds":["22"]},"t":"sh"},"49":{"i":{"co":{"cIds":{"2":["4","8","2","13"]}},"operator":"OR","groups":[{"operator":"AND","checks":[{"fieldId":"2","type":"SOME_OF","constraint":["4","8","2","13"]}]}]},"o":{"sIds":["9"]},"t":"sh"},"53":{"i":{"co":{"cIds":{"2":["3"]}}},"o":{"sIds":["1"]},"t":"sh"},"156":{"i":{"co":{"cIds":{"2":["12"]}},"operator":"OR","groups":[{"operator":"AND","checks":[{"fieldId":"2","type":"SOME_OF","constraint":["12"]}]}]},"o":{"sIds":["29"]},"t":"sh"},"167":{"i":{"co":{"cIds":{"2":["12"]}},"operator":"OR","groups":[{"operator":"AND","checks":[{"fieldId":"2","type":"SOME_OF","constraint":["12"]}]}]},"o":{"sIds":["6"]},"t":"sh"},"125":{"i":{"co":{"cIds":{"124":["2"]}}},"o":{"sIds":["12"]},"t":"sh"},"119":{"i":{"co":{"cIds":{"100":["2"]}}},"o":{"sIds":["24"]},"t":"sh"},"98":{"i":{"co":{"cIds":{"2":["10"]}}},"o":{"sIds":["20"]},"t":"sh"},"113":{"i":{"co":{"cIds":{"104":["1"]}}},"o":{"sIds":["23"]},"t":"sh"},"120":{"i":{"co":{"cIds":{"2":["2","4","8","13"]}},"operator":"OR","groups":[{"operator":"AND","checks":[{"fieldId":"2","type":"SOME_OF","constraint":["2","4","8","13"]}]}]},"o":{"sIds":["25"]},"t":"sh"},"84":{"i":{"co":{"cIds":{"75":["1"]}}},"o":{"sIds":["16"]},"t":"sh"},"78":{"i":{"co":{"cIds":{"92":["1"]}}},"o":{"sIds":["18"]},"t":"sh"},"90":{"i":{"co":{"cIds":{"19":["1"]}}},"o":{"sIds":["10"]},"t":"sh"},"141":{"i":{"co":{"cIds":{"2":["11"]}}},"o":{"sIds":["28"]},"t":"sh"},"163":{"i":{"co":{"cIds":{"159":["2"]}},"operator":"OR","groups":[{"operator":"AND","checks":[{"fieldId":"159","type":"SOME_OF","constraint":["2"]}]}]},"o":{"sIds":["31"]},"t":"sh"},"123":{"i":{"co":{"cIds":{"2":["7"]}}},"o":{"sIds":["11"]},"t":"sh"},"107":{"i":{"co":{"cIds":{"100":["1"]}}},"o":{"sIds":["21"]},"t":"sh"},"46":{"i":{"co":{"cIds":{"124":["1","2"]}}},"o":{"sIds":["27"]},"t":"sh"},"80":{"i":{"co":{"cIds":{"2":["2","7","4","8","13"]}},"operator":"OR","groups":[{"operator":"AND","checks":[{"fieldId":"2","type":"SOME_OF","constraint":["2","7","4","8","13"]}]}]},"o":{"sIds":["7"]},"t":"sh"},"137":{"i":{"co":{"cIds":{"134":["1","2"]}}},"o":{"sIds":["14"]},"t":"sh"},"47":{"i":{"co":{"cIds":{"33":["1"]}}},"o":{"sIds":["26"]},"t":"sh"},"122":{"i":{"co":{"cIds":{"2":["7"]}}},"o":{"sIds":["3"]},"t":"sh"},"162":{"i":{"co":{"cIds":{"159":["1"]}},"operator":"OR","groups":[{"operator":"AND","checks":[{"fieldId":"159","type":"SOME_OF","constraint":["1"]}]}]},"o":{"sIds":["30"]},"t":"sh"},"52":{"i":{"co":{"cIds":{"2":["2","9","10","8","13"]}},"operator":"OR","groups":[{"operator":"AND","checks":[{"fieldId":"2","type":"SOME_OF","constraint":["2","9","10","8","13"]}]}]},"o":{"sIds":["2"]},"t":"sh"},"85":{"i":{"co":{"cIds":{"2":["9"]}}},"o":{"sIds":["17"]},"t":"sh"}},"sections":{"12":{"name":"Blood Bank 3","conditions":["125"]},"8":{"name":"A5 Personalised Part 3","conditions":["54"]},"4":{"name":"A5 Cervical","conditions":["155"]},"22":{"name":"SCOPE 3","conditions":["108"]},"26":{"name":"A5 Personalised Part 7","conditions":["47"]},"13":{"name":"Blood Bank 4","conditions":["135"]},"5":{"name":"A5 Personalised ALL ","conditions":["51"]},"10":{"name":"A5 Personalised Part 5","conditions":["90"]},"21":{"name":"SCOPE 2","conditions":["107"]},"31":{"name":"A5 BEN Blood Bank","conditions":["163"]},"2":{"name":"A5 Personalised Part","conditions":["52"]},"18":{"name":"INFCON 4","conditions":["78"]},"29":{"name":"Bendigo Bulk","conditions":["156"]},"3":{"name":"Blood Bank","conditions":["122"]},"28":{"name":"Mercy","conditions":["141"]},"19":{"name":"New INFCON","conditions":["79"]},"23":{"name":"SCOPE 4","conditions":["113"]},"15":{"name":"INFCON","conditions":["59"]},"11":{"name":"Blood Bank 2","conditions":["123"]},"9":{"name":"A5 Personalised Part 4","conditions":["49"]},"24":{"name":"SCOPE 5","conditions":["119"]},"16":{"name":"INFCON 2","conditions":["84"]},"6":{"name":"A5 BEN Bulk","conditions":["167"]},"1":{"name":"A4 PS","conditions":["53"]},"17":{"name":"INFCON 3","conditions":["85"]},"25":{"name":"A5 Personalised Part 6","conditions":["120"]},"14":{"name":"Blood Bank 5","conditions":["137"]},"20":{"name":"SCOPE","conditions":["98"]},"27":{"name":"Blood Bank 4","conditions":["46"]},"30":{"name":"A5 HCF BEN","conditions":["162"]},"7":{"name":"A5 Personalised Part 2","conditions":["80"]}},"questions":{"66":{"type":"ts","label":"Infection Control Contact Number","description":"For urgent result notification","validation":{"rq":true},"choices":[],"questionKey":""},"33":{"type":"cs","label":"Do you want to add a copy to?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"55":{"type":"ts","label":"Ward","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"106":{"type":"cs","label":"Type of Scope Form","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Washing and Brushing ","other":false},{"id":"2","label":"Filter (Re-processor Filter)","other":false}],"questionKey":""},"118":{"type":"rt","label":"Special Instructions","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"150":{"type":"cs","label":"Type of Form","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Mercy Blank Form (HCF = MHW)","other":false},{"id":"2","label":"Dr A Shub - Emergency Department","other":false},{"id":"3","label":"Dr A Shub - Blood Bank","other":false},{"id":"4","label":"Dr M Rasmussen","other":false},{"id":"5","label":"Neonatal - Blue","other":false},{"id":"6","label":"Neonatal - Green","other":false}],"questionKey":""},"67":{"type":"ts","label":"After Hours Number","description":"If different from regular number","validation":{"rq":false},"choices":[],"questionKey":""},"153":{"type":"cd","label":"Number of Pads Required","description":"1 pad = 100 forms","validation":{"rq":true},"choices":[{"id":"3","label":"8","other":false},{"id":"4","label":"12","other":false},{"id":"6","label":"16","other":false},{"id":"10","label":"24","other":false}],"questionKey":""},"124":{"type":"cs","label":"Type of Form","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Blank","other":false},{"id":"2","label":"Personalised","other":false}],"questionKey":""},"8":{"type":"cs","label":"Labels on forms?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"164":{"type":"cs","label":"Number of Pads Required","description":"1 Pad = 50 requests","validation":{"rq":true},"choices":[{"id":"1","label":"80","other":false},{"id":"2","label":"120","other":false}],"questionKey":""},"19":{"type":"cs","label":"Is this a reorder of an existing form?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"100":{"type":"cs","label":"Is this a reorder of an existing form?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"128":{"type":"ts","label":"HCF","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"4":{"type":"no","label":"Number of Pads Required","description":"1 pad - 100 forms","validation":{"rq":true,"mnn":1,"mxn":100,"wh":true},"choices":[],"questionKey":""},"15":{"type":"tl","label":"Delivery Address","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"9":{"type":"rt","label":"Special Instructions","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"11":{"type":"cd","label":"Number of Pads Required","description":"1 pad = 100 forms","validation":{"rq":true},"choices":[{"id":"11","label":"Digital Request Form","other":false},{"id":"1","label":"2","other":false},{"id":"2","label":"4","other":false},{"id":"3","label":"8","other":false},{"id":"4","label":"12","other":false},{"id":"6","label":"20","other":false},{"id":"10","label":"40","other":false}],"questionKey":""},"104":{"type":"cs","label":"Any changes to the existing form?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"134":{"type":"cs","label":"Is this a reorder of an existing form?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"174":{"type":"ts","label":"Department/Ward Name","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"37":{"type":"tl","label":"Provider Number","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"166":{"type":"rt","label":"Special Instructions","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"13":{"type":"ts","label":"HCF/GP Practice Name","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"177":{"type":"tl","label":"Delivery Address","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"94":{"type":"ts","label":"Infection Control Coordinator Name","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"35":{"type":"tl","label":"Name","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"152":{"type":"cd","label":"Number of Pads Required","description":"1 pad = 50 forms","validation":{"rq":true},"choices":[{"id":"7","label":"Digital Request Form","other":false},{"id":"1","label":"2","other":false},{"id":"2","label":"4","other":false},{"id":"3","label":"8","other":false},{"id":"4","label":"12","other":false},{"id":"5","label":"20","other":false},{"id":"6","label":"40","other":false}],"questionKey":""},"5":{"type":"tl","label":"HCF/GP Practice","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"112":{"type":"rt","label":"Required Changes","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"159":{"type":"cs","label":"Type of Form","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"A5 HCF BEN","other":false},{"id":"2","label":"A5 BEN Blood Bank","other":false}],"questionKey":""},"144":{"type":"ts","label":"Number of Boxes","description":"1 Box = 40 Pads","validation":{"rq":true},"choices":[],"questionKey":""},"87":{"type":"tl","label":"Contact Name","description":"Please enter your full name","validation":{"rq":true},"choices":[],"questionKey":""},"116":{"type":"ts","label":"Phone Number","description":"For urgent result notification","validation":{"rq":true},"choices":[],"questionKey":""},"76":{"type":"cs","label":"Type of Infection Control form","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Healthcare Worker Immunity Check ","other":false},{"id":"2","label":"Exposure Recipient ","other":false},{"id":"3","label":"Exposure Source","other":false},{"id":"0","label":"Other...","other":true}],"questionKey":""},"148":{"type":"ts","label":"Ward","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"127":{"type":"tl","label":"Doctor Name","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"65":{"type":"rt","label":"Special Instructions ","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"32":{"type":"cd","label":"Type of Patients","description":"","validation":{"rq":false},"choices":[{"id":"1","label":"Inpatients","other":false},{"id":"2","label":"Outpatients","other":false},{"id":"3","label":"Both","other":false}],"questionKey":""},"82":{"type":"ts","label":"Ward","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"6":{"type":"ts","label":"Contact Number:","description":" ","validation":{"rq":true},"choices":[],"questionKey":""},"36":{"type":"tl","label":"Location","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"39":{"type":"ts","label":"Healthlink EDI","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"140":{"type":"rt","label":"Special Instructions","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"173":{"type":"ts","label":"Contact Number","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"14":{"type":"ts","label":"Contact Number:","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"111":{"type":"rt","label":"Required Changes","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"31":{"type":"rt","label":"Special Instructions","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"58":{"type":"cs","label":"Are you at a hospital site?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"145":{"type":"rt","label":"Special Instructions","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"75":{"type":"cs","label":"Is this a reorder of an existing form?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"115":{"type":"ts","label":"Contact Name","description":"Key scope testing contact","validation":{"rq":true},"choices":[],"questionKey":""},"149":{"type":"ts","label":"Contact Number","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"27":{"type":"tl","label":"Doctor Name","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"2":{"type":"cs","label":"Type of Request Pad","description":"","validation":{"rq":true},"choices":[{"id":"3","label":"A4 Practice Software","other":false},{"id":"2","label":"A5 Personalised","other":false},{"id":"7","label":"A5 Blood Bank","other":false},{"id":"4","label":"A5 Cervical","other":false},{"id":"8","label":"A5 Cytology","other":false},{"id":"13","label":"A5 Endoscopy","other":false},{"id":"9","label":"A5 Infection Control","other":false},{"id":"10","label":"A5 Scope","other":false},{"id":"11","label":"A5 Mercy - Bulk Order","other":false},{"id":"12","label":"A5 Bendigo - Bulk Order","other":false}],"questionKey":""},"38":{"type":"no","label":"Fax","description":"","validation":{"rq":false,"wh":false},"choices":[],"questionKey":""},"165":{"type":"rt","label":"Special Instructions","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"92":{"type":"cs","label":"Any changes to the existing form?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"30":{"type":"ts","label":"Ward","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"7":{"type":"tl","label":"Delivery Address","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"97":{"type":"ts","label":"Ward","description":"","validation":{"rq":true},"choices":[],"questionKey":""},"130":{"type":"ts","label":"Ward","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"129":{"type":"tl","label":"Provider Number(s)","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"29":{"type":"tl","label":"Provider Number(s)","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"28":{"type":"ts","label":"HCF","description":"","validation":{"rq":false},"choices":[],"questionKey":""},"161":{"type":"ts","label":"Number of Boxes","description":"1 Box = 40 Pads","validation":{"rq":true},"choices":[],"questionKey":""},"146":{"type":"tl","label":"Delivery Address","description":"","validation":{"rq":true},"choices":[],"questionKey":""}}},"uuid":"56d81a27-494e-46d1-8f93-2a2e20630c5d"},"linkedJiraFields":[]},"key":""},"portalWebFragments":{"headerPanels":[],"subheaderPanels":[],"footerPanels":[],"pagePanels":{"propertyPanels":[],"legacyPropertyPanels":[]}}}