{"id":198,"date":"2026-08-07T20:41:13","date_gmt":"2026-08-07T20:41:13","guid":{"rendered":"https:\/\/audit-m5ph3bhgpsrd.wpauditlab.com\/?page_id=198"},"modified":"2026-08-07T20:41:13","modified_gmt":"2026-08-07T20:41:13","slug":"case648-owner-form-page","status":"publish","type":"page","link":"https:\/\/audit-m5ph3bhgpsrd.wpauditlab.com\/?page_id=198","title":{"rendered":"Case 648 Owner Form Page"},"content":{"rendered":"<p><div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-192\"><form id=\"wpforms-form-192\" class=\"wpforms-validate wpforms-form\" data-formid=\"192\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F198\" data-token=\"8a562217d43755393b5cf883aa63cf23\" data-token-time=\"1786327442\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-192-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><label class=\"wpforms-field-label\">Patient Name<\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-192-field_1\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][1][first]\" ><label for=\"wpforms-192-field_1\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-192-field_1-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][1][last]\" ><label for=\"wpforms-192-field_1-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><div class=\"wpforms-field-description\">Generated by AI for admin owner; scoped marker CASE648-OWNER-PII<\/div><\/div><div id=\"wpforms-192-field_2-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-192-field_2\">Private Contact Email<\/label><input type=\"email\" id=\"wpforms-192-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" spellcheck=\"false\" ><div class=\"wpforms-field-description\">PII fixture CASE648-OWNER-PII: do not expose across sessions<\/div><\/div><div id=\"wpforms-192-field_3-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-192-field_3\">Confidential Intake Notes <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-192-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" required><\/textarea><div class=\"wpforms-field-description\">Private generated content for admin owner<\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"192\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/audit-m5ph3bhgpsrd.wpauditlab.com\/index.php?rest_route=\/wp\/v2\/pages\/198\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-192\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit Secure Intake\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit Secure Intake<\/button><\/div><\/form><\/div>  <!-- .wpforms-container --><br \/>\n<!-- CASE648 owner parent page --><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":70,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-198","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/audit-m5ph3bhgpsrd.wpauditlab.com\/index.php?rest_route=\/wp\/v2\/pages\/198","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/audit-m5ph3bhgpsrd.wpauditlab.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/audit-m5ph3bhgpsrd.wpauditlab.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/audit-m5ph3bhgpsrd.wpauditlab.com\/index.php?rest_route=\/wp\/v2\/users\/70"}],"replies":[{"embeddable":true,"href":"https:\/\/audit-m5ph3bhgpsrd.wpauditlab.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=198"}],"version-history":[{"count":0,"href":"https:\/\/audit-m5ph3bhgpsrd.wpauditlab.com\/index.php?rest_route=\/wp\/v2\/pages\/198\/revisions"}],"wp:attachment":[{"href":"https:\/\/audit-m5ph3bhgpsrd.wpauditlab.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=198"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}