{"id":42,"date":"2016-05-26T16:47:16","date_gmt":"2016-05-26T16:47:16","guid":{"rendered":"http:\/\/localhost\/lincolnpharmacy\/?page_id=42"},"modified":"2021-03-16T05:38:33","modified_gmt":"2021-03-16T05:38:33","slug":"pharmacy-transfer-rx","status":"publish","type":"page","link":"https:\/\/www.yourlincolnpharmacy.com\/index.php\/pharmacy-transfer-rx\/","title":{"rendered":"Transfer RX"},"content":{"rendered":"<p>To transfer your prescription to us, please carefully follow the instructions and fill out the form below.<\/p>\n\n\n<div class=\"wp-block-contact-form-7-contact-form-selector\"><div role=\"form\" class=\"wpcf7\" id=\"wpcf7-f606-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/42#wpcf7-f606-o1\" method=\"post\" class=\"wpcf7-form init\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"606\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.4\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f606-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<div class=\"head\">\n<div class=\"col\">\n<div class=\"col-1\">\n   <label> Patient Details <\/label>\n  <\/div>\n<\/div>\n<div class=\"col\">\n<div class=\"col-2\">\n   <label> First Name <span class=\"required\">*<\/span><br \/>\n     <span class=\"wpcf7-form-control-wrap first-name\"><input type=\"text\" name=\"first-name\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label>\n  <\/div>\n<div class=\"col-2\">\n   <label> Last Name <span class=\"required\">*<\/span><br \/>\n     <span class=\"wpcf7-form-control-wrap last-name\"><input type=\"text\" name=\"last-name\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label>\n  <\/div>\n<\/div>\n<div class=\"col\">\n<div class=\"col-2\">\n   <label> Date of Birth <span class=\"required\">*<\/span><br \/>\n     <span class=\"wpcf7-form-control-wrap date-of-birth\"><input type=\"text\" name=\"date-of-birth\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label>\n  <\/div>\n<div class=\"col-2\">\n   <label> Phone Number <span class=\"required\">*<\/span><br \/>\n     <span class=\"wpcf7-form-control-wrap phone-number\"><input type=\"text\" name=\"phone-number\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label>\n  <\/div>\n<\/div>\n<div class=\"col\">\n<div class=\"col-2\">\n   <label> Address<span class=\"required\">*<\/span><br \/>\n     <span class=\"wpcf7-form-control-wrap address\"><input type=\"text\" name=\"address\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label>\n  <\/div>\n<div class=\"col-2\">\n   <label> City <span class=\"required\">*<\/span><br \/>\n     <span class=\"wpcf7-form-control-wrap city\"><input type=\"text\" name=\"city\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label>\n  <\/div>\n<\/div>\n<div class=\"col\">\n<div class=\"col-2\">\n   <label> State<span class=\"required\">*<\/span><br \/>\n     <span class=\"wpcf7-form-control-wrap state\"><input type=\"text\" name=\"state\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label>\n  <\/div>\n<div class=\"col-2\">\n   <label> Zip\/Postal Code <span class=\"required\">*<\/span><br \/>\n     <span class=\"wpcf7-form-control-wrap zip-or-postal-code\"><input type=\"text\" name=\"zip-or-postal-code\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label>\n  <\/div>\n<\/div>\n<div class=\"col\">\n<div class=\"col-2\">\n   <label> Pharmacy Name<span class=\"required\">*<\/span><br \/>\n     <span class=\"wpcf7-form-control-wrap pharmacy-name\"><input type=\"text\" name=\"pharmacy-name\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label>\n  <\/div>\n<div class=\"col-2\">\n   <label> Pharmacy Phone <span class=\"required\">*<\/span><br \/>\n     <span class=\"wpcf7-form-control-wrap pharmacy-phone\"><input type=\"text\" name=\"pharmacy-phone\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label>\n  <\/div>\n<\/div>\n<div class=\"col\">\n<div class=\"col-1\">\n   <label> Prescriptions to be transferred<\/label><br \/>\n   <q>If you would like to transfer all prescriptions, simply check the box below.<\/q>\n  <\/div>\n<\/div>\n<div class=\"col\">\n<div class=\"col-1\">\n   <span class=\"wpcf7-form-control-wrap checkbox-757\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"checkbox-757[]\" value=\"Transfer all my prescriptions\" \/><span class=\"wpcf7-list-item-label\">Transfer all my prescriptions<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n<\/div>\n<div class=\"col\">\n<div class=\"col-1\">\n   <q>If you would like to selectively transfer your prescriptions, simply start typing to find your medication.<\/q><br \/>\n   <label> List specific prescriptions to be transferred<\/label>\n  <\/div>\n<\/div>\n<div class=\"col\">\n<div class=\"col-2\">\n   <label> Rx1 Med Name<br \/>\n     <span class=\"wpcf7-form-control-wrap rx1-med-name\"><input type=\"text\" name=\"rx1-med-name\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label>\n  <\/div>\n<div class=\"col-2\">\n   <label> Rx1 Number<br \/>\n     <span class=\"wpcf7-form-control-wrap rx1-number\"><input type=\"text\" name=\"rx1-number\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label>\n  <\/div>\n<\/div>\n<div class=\"col\">\n<div class=\"col-2\">\n   <label> Rx2 Med Name<br \/>\n     <span class=\"wpcf7-form-control-wrap rx2-med-name\"><input type=\"text\" name=\"rx2-med-name\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label>\n  <\/div>\n<div class=\"col-2\">\n   <label> Rx2 Number<br \/>\n     <span class=\"wpcf7-form-control-wrap rx2-number\"><input type=\"text\" name=\"rx2-number\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label>\n  <\/div>\n<\/div>\n<div class=\"col\">\n<div class=\"col-2\">\n   <label> Rx3 Med Name<br \/>\n     <span class=\"wpcf7-form-control-wrap rx3-med-name\"><input type=\"text\" name=\"rx3-med-name\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label>\n  <\/div>\n<div class=\"col-2\">\n   <label> Rx3 Number<br \/>\n     <span class=\"wpcf7-form-control-wrap rx3-number\"><input type=\"text\" name=\"rx3-number\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label>\n  <\/div>\n<\/div>\n<div class=\"col\">\n<div class=\"col-2\">\n   <label> Rx4 Med Name<br \/>\n     <span class=\"wpcf7-form-control-wrap rx4-med-name\"><input type=\"text\" name=\"rx4-med-name\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label>\n  <\/div>\n<div class=\"col-2\">\n   <label> Rx4 Number<br \/>\n     <span class=\"wpcf7-form-control-wrap rx4-number\"><input type=\"text\" name=\"rx4-number\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label>\n  <\/div>\n<\/div>\n<div class=\"col\">\n<div class=\"col-2\">\n   <label> Rx5 Med Name<br \/>\n     <span class=\"wpcf7-form-control-wrap rx5-med-name\"><input type=\"text\" name=\"rx5-med-name\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label>\n  <\/div>\n<div class=\"col-2\">\n   <label> Rx5 Number<br \/>\n     <span class=\"wpcf7-form-control-wrap rx5-number\"><input type=\"text\" name=\"rx5-number\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label>\n  <\/div>\n<\/div>\n<p><input type=\"submit\" value=\"Submit\" class=\"wpcf7-form-control wpcf7-submit\" \/>\n<\/p><\/div>\n<div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div><\/form><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>To transfer your prescription to us, please carefully follow the instructions and fill out the form below.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/www.yourlincolnpharmacy.com\/index.php\/wp-json\/wp\/v2\/pages\/42"}],"collection":[{"href":"https:\/\/www.yourlincolnpharmacy.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.yourlincolnpharmacy.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.yourlincolnpharmacy.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.yourlincolnpharmacy.com\/index.php\/wp-json\/wp\/v2\/comments?post=42"}],"version-history":[{"count":3,"href":"https:\/\/www.yourlincolnpharmacy.com\/index.php\/wp-json\/wp\/v2\/pages\/42\/revisions"}],"predecessor-version":[{"id":609,"href":"https:\/\/www.yourlincolnpharmacy.com\/index.php\/wp-json\/wp\/v2\/pages\/42\/revisions\/609"}],"wp:attachment":[{"href":"https:\/\/www.yourlincolnpharmacy.com\/index.php\/wp-json\/wp\/v2\/media?parent=42"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}