{"id":1142,"date":"2026-02-09T17:22:52","date_gmt":"2026-02-09T17:22:52","guid":{"rendered":"https:\/\/mchdep.org\/?page_id=1142"},"modified":"2026-02-09T17:35:18","modified_gmt":"2026-02-09T17:35:18","slug":"social-services-contact-form","status":"publish","type":"page","link":"https:\/\/mchdep.org\/es\/social-services-contact-form\/","title":{"rendered":"Formulario de contacto de Servicios Sociales"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1142\" class=\"elementor elementor-1142\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1fc6c5d e-flex e-con-boxed e-con e-parent\" data-id=\"1fc6c5d\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-9870d54 exad-sticky-section-no exad-glass-effect-no elementor-widget elementor-widget-heading\" data-id=\"9870d54\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Maverick County Hospital District<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6550c3c exad-sticky-section-no exad-glass-effect-no elementor-widget elementor-widget-heading\" data-id=\"6550c3c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Social Services Contact Form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-0442710 e-flex e-con-boxed e-con e-parent\" data-id=\"0442710\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-34c9f20 elementor-widget__width-initial elementor-button-align-stretch exad-sticky-section-no exad-glass-effect-no elementor-widget elementor-widget-form\" data-id=\"34c9f20\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Siguiente&quot;,&quot;step_previous_label&quot;:&quot;Anterior&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Nuevo formulario\" aria-label=\"Nuevo formulario\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"1142\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"34c9f20\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Social Services Contact Form\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"1142\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Email\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_8005f43 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_8005f43]\" id=\"form-field-field_8005f43\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Phone\" required=\"required\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_31b064b elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_31b064b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSelect Social Services\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-eicon-caret-down\" viewBox=\"0 0 571.4 571.4\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M571 393Q571 407 561 418L311 668Q300 679 286 679T261 668L11 418Q0 407 0 393T11 368 36 357H536Q550 357 561 368T571 393Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_31b064b]\" id=\"form-field-field_31b064b\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Breast and Cervical Cancer Services\">Breast and Cervical Cancer Services<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Indigent Program \/ MFAP \">Indigent Program \/ MFAP <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"HIV Ryan White Services\">HIV Ryan White Services<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_b926839 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_b926839]\" id=\"form-field-field_b926839\" rows=\"4\" placeholder=\"Leave a Note\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-far-envelope\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M464 64H48C21.49 64 0 85.49 0 112v288c0 26.51 21.49 48 48 48h416c26.51 0 48-21.49 48-48V112c0-26.51-21.49-48-48-48zm0 48v40.805c-22.422 18.259-58.168 46.651-134.587 106.49-16.841 13.247-50.201 45.072-73.413 44.701-23.208.375-56.579-31.459-73.413-44.701C106.18 199.465 70.425 171.067 48 152.805V112h416zM48 400V214.398c22.914 18.251 55.409 43.862 104.938 82.646 21.857 17.205 60.134 55.186 103.062 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Form<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-1142","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/mchdep.org\/es\/wp-json\/wp\/v2\/pages\/1142","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mchdep.org\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/mchdep.org\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/mchdep.org\/es\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/mchdep.org\/es\/wp-json\/wp\/v2\/comments?post=1142"}],"version-history":[{"count":19,"href":"https:\/\/mchdep.org\/es\/wp-json\/wp\/v2\/pages\/1142\/revisions"}],"predecessor-version":[{"id":1163,"href":"https:\/\/mchdep.org\/es\/wp-json\/wp\/v2\/pages\/1142\/revisions\/1163"}],"wp:attachment":[{"href":"https:\/\/mchdep.org\/es\/wp-json\/wp\/v2\/media?parent=1142"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}