{"id":17058,"date":"2020-12-15T12:14:55","date_gmt":"2020-12-15T18:14:55","guid":{"rendered":"https:\/\/mitchellhamline.edu\/news\/?page_id=17058"},"modified":"2024-07-17T09:33:34","modified_gmt":"2024-07-17T14:33:34","slug":"covid-19-reporting-form","status":"publish","type":"page","link":"https:\/\/mitchellhamline.edu\/news\/covid-19-reporting-form\/","title":{"rendered":"COVID-19 reporting form"},"content":{"rendered":"<div class=\"introduction-wrapper\">\n<h2>Please complete this form if you have tested positive for COVID-19<\/h2>\n<p>This form collects the key data needed for contact tracing in the event of a potential exposure to a Mitchell Hamline community member.<\/p>\n<p>If you have tested positive for COVID-19, you should stay home if you are experiencing symptoms.\u00a0 You are able to return to work when you are feeling well and have been fever-free without the use of medication for at least 24 hours.<\/p>\n<\/div>\n<div class=\"frm_forms  with_frm_style frm_style_sleek-smooth-style\" id=\"frm_form_10_container\" ><form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_js_validate  frm_ajax_submit  frm_pro_form \" id=\"form_covid-19reportingform\" ><div class=\"frm_form_fields \"><fieldset><legend class=\"frm_screen_reader\">COVID-19 reporting form<\/legend><div class=\"frm_fields_container\"><input type=\"hidden\" name=\"frm_action\" value=\"create\" \/><input type=\"hidden\" name=\"form_id\" value=\"10\" \/><input type=\"hidden\" name=\"frm_hide_fields_10\" id=\"frm_hide_fields_10\" value=\"\" \/><input type=\"hidden\" name=\"form_key\" value=\"covid-19reportingform\" \/><input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/><input type=\"hidden\" id=\"frm_submit_entry_10\" name=\"frm_submit_entry_10\" value=\"039b6ea035\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/news\/wp-json\/wp\/v2\/pages\/17058\" \/><div id=\"frm_field_115_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\"><label for=\"field_42qfe\" id=\"field_42qfe_label\" class=\"frm_primary_label\">First name<span class=\"frm_required\">*<\/span><\/label><input  type=\"text\" id=\"field_42qfe\" name=\"item_meta[115]\" value=\"\"  data-reqmsg=\"First name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/><\/div><div id=\"frm_field_116_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\"><label for=\"field_25puk\" id=\"field_25puk_label\" class=\"frm_primary_label\">Last name<span class=\"frm_required\">*<\/span><\/label><input  type=\"text\" id=\"field_25puk\" name=\"item_meta[116]\" value=\"\"  data-reqmsg=\"Last name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/><\/div><div id=\"frm_field_123_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\"><label for=\"field_o7gmz\" id=\"field_o7gmz_label\" class=\"frm_primary_label\">When were you last on campus?*<span class=\"frm_required\">*<\/span><\/label><input type=\"text\" id=\"field_o7gmz\" name=\"item_meta[123]\" value=\"\"  maxlength=\"10\" data-reqmsg=\"When were you last on campus?* cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/><\/div><div id=\"frm_field_124_container\" class=\"frm_form_field form-field  frm_top_container frm6\"><div  id=\"field_s9rdj_label\" class=\"frm_primary_label\">Time<span class=\"frm_required\"><\/span><\/div><div class=\"frm_time_wrap\"><span dir=\"ltr\"><select aria-label=\"Time ... hour\" name=\"item_meta[124][H]\" id=\"field_s9rdj_H\"  data-frmval=\"{&quot;H&quot;:&quot;&quot;,&quot;m&quot;:&quot;&quot;,&quot;A&quot;:&quot;&quot;,&quot;s&quot;:&quot;&quot;,&quot;ms&quot;:&quot;&quot;}\" data-invmsg=\"Time is invalid\" class=\"auto_width frm_time_select\" aria-invalid=\"false\"  ><option value=\"\"  selected='selected'><\/option><option value=\"12\" >12<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><\/select><span class=\"frm_time_sep\" aria-hidden=\"true\">:<\/span><select aria-label=\"Time ... minute\" name=\"item_meta[124][m]\" id=\"field_s9rdj_m\"  data-frmval=\"{&quot;H&quot;:&quot;&quot;,&quot;m&quot;:&quot;&quot;,&quot;A&quot;:&quot;&quot;,&quot;s&quot;:&quot;&quot;,&quot;ms&quot;:&quot;&quot;}\" data-invmsg=\"Time is invalid\" class=\"auto_width frm_time_select auto_width frm_time_select\" aria-invalid=\"false\"  ><option value=\"\"  selected='selected'><\/option><option value=\"00\" >00<\/option><option value=\"30\" >30<\/option><\/select><\/span><select aria-label=\"Time\" name=\"item_meta[124][A]\" id=\"field_s9rdj_A\"  data-frmval=\"{&quot;H&quot;:&quot;&quot;,&quot;m&quot;:&quot;&quot;,&quot;A&quot;:&quot;&quot;,&quot;s&quot;:&quot;&quot;,&quot;ms&quot;:&quot;&quot;}\" data-invmsg=\"Time is invalid\" class=\"auto_width frm_time_select auto_width frm_time_select auto_width frm_time_select\" aria-invalid=\"false\"  ><option value=\"AM\" >AM<\/option><option value=\"PM\" >PM<\/option><\/select><\/div><\/div><div id=\"frm_field_127_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\"><label for=\"field_5u4tm\" id=\"field_5u4tm_label\" class=\"frm_primary_label\">In the 48 hours before you developed symptoms: Which individuals on campus have you been in close contact with on or off campus (within 6 feet or had physical contact with)? <span class=\"frm_required\">*<\/span><\/label><textarea name=\"item_meta[127]\" id=\"field_5u4tm\" rows=\"5\"  data-reqmsg=\"In the 48 hours before you developed symptoms: Which individuals on campus have you been in close contact with on or off campus (within 6 feet or had physical contact with)?  cannot be blank.\" aria-required=\"true\" data-invmsg=\"In the 48 hours before you developed symptoms: Which individuals on campus have you been in close contact with on or off campus (within 6 feet or had physical contact with)?  is invalid\" aria-invalid=\"false\"  ><\/textarea><\/div><div id=\"frm_field_134_container\" class=\"frm_form_field form-field  frm_none_container\"><label for=\"g-recaptcha-response\" id=\"field_of4v0_label\" class=\"frm_primary_label\">Captcha<span class=\"frm_required\"><\/span><\/label><div  id=\"field_of4v0\" class=\"frm-g-recaptcha\" data-sitekey=\"6Lc60SsUAAAAACBhG8Aftah6ObEfAyK6R_QBSsF1\" data-size=\"invisible\" data-theme=\"light\"><\/div><\/div><input type=\"hidden\" name=\"item_key\" value=\"\" \/><div id=\"frm_field_136_container\"><label for=\"field_iqyr0\" >If you are human, leave this field blank.<\/label><input  id=\"field_iqyr0\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[136]\" value=\"\"  \/><\/div><input name=\"frm_state\" type=\"hidden\" value=\"64RpfnXZHzNTDumn9tYWKjBCBQArMCNLCDZYNDh7woXn+ivduf6hKj9gzCM8diyX\" \/><div class=\"frm_submit\"><button class=\"frm_button_submit frm_final_submit\" type=\"submit\"  >Submit<\/button><\/div><\/div><\/fieldset><\/div><\/form><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Please complete this form if you have tested positive for COVID-19 This form collects the key data needed for contact tracing in the event of a potential exposure to a Mitchell Hamline community member. If you have tested positive for COVID-19, you should stay home if you are experiencing symptoms.\u00a0 You are able to return &hellip; <\/p>\n<p><a href=\"https:\/\/mitchellhamline.edu\/news\/covid-19-reporting-form\/\" class=\"more-link\">COVID-19 reporting form<\/a><\/p>\n","protected":false},"author":4872,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"class_list":["post-17058","page","type-page","status-publish","entry"],"acf":[],"_links":{"self":[{"href":"https:\/\/mitchellhamline.edu\/news\/wp-json\/wp\/v2\/pages\/17058","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mitchellhamline.edu\/news\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/mitchellhamline.edu\/news\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/mitchellhamline.edu\/news\/wp-json\/wp\/v2\/users\/4872"}],"replies":[{"embeddable":true,"href":"https:\/\/mitchellhamline.edu\/news\/wp-json\/wp\/v2\/comments?post=17058"}],"version-history":[{"count":0,"href":"https:\/\/mitchellhamline.edu\/news\/wp-json\/wp\/v2\/pages\/17058\/revisions"}],"wp:attachment":[{"href":"https:\/\/mitchellhamline.edu\/news\/wp-json\/wp\/v2\/media?parent=17058"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}