{"id":9253,"date":"2025-11-13T10:38:23","date_gmt":"2025-11-13T18:38:23","guid":{"rendered":"https:\/\/accuroemr.com\/STAGING\/?page_id=9253"},"modified":"2025-11-13T10:39:08","modified_gmt":"2025-11-13T18:39:08","slug":"heidi-multi-provider-form","status":"publish","type":"page","link":"https:\/\/accuroemr.com\/STAGING\/heidi-multi-provider-form\/","title":{"rendered":"Heidi Multi Provider Form"},"content":{"rendered":"<div id=\"cs-content\" class=\"cs-content\"><div class=\"x-section e9253-e1 m751-0 m751-1 m751-2\" id=\"fixed-header\"><div class=\"x-row x-container max width e9253-e2 m751-5 m751-6 m751-7\"><div class=\"x-row-inner\"><div class=\"x-col e9253-e3 m751-a\"><div class=\"x-image e9253-e4 m751-b\"><img decoding=\"async\" src=\"https:\/\/accuroemr.com\/STAGING\/wp-content\/uploads\/2023\/05\/Accuro-Logo_Colour-Combomark-Process-RGB-1.svg\" width=\"225\" height=\"30\" alt=\"Image\" loading=\"lazy\"><\/div><\/div><div class=\"x-col e9253-e5 m751-a\"><\/div><\/div><\/div><\/div><div class=\"x-section e9253-e6 m751-0 m751-3 m751-4\"><div class=\"x-row x-container max width e9253-e7 m751-5 m751-6 m751-8\"><div class=\"x-row-inner\"><div class=\"x-col e9253-e8 m751-a\"><div class=\"x-text x-content e9253-e9 m751-d m751-e\"><div class=\"primed-intro\">\n<h3>Accuro AI Scribe - Powered by Heidi, multi-provider form.<\/h3>\n<p>Please fill all required fields below.<\/p>\n\n<\/div><\/div><div class=\"x-form-integration x-form-integration-gravity-forms e9253-e10 m751-g\"><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_12' style='display:none'><form method='post' enctype='multipart\/form-data'  id='gform_12'  action='\/STAGING\/wp-json\/wp\/v2\/pages\/9253' data-formid='12' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_12' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_12_1\" class=\"gfield gfield--type-select gfield--input-type-select poi gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_1'>Are you currently using Heidi?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_1' id='input_12_1' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Are you currently using Heidi? *<\/option><option value='Yes, All users in my clinic are currently using Heidi' >Yes, All users in my clinic are currently using Heidi<\/option><option value='No, my clinic is not yet using Heidi' >No, my clinic is not yet using Heidi<\/option><option value='Some users are currently using Heidi' >Some, but not all users are currently using Heidi<\/option><\/select><\/div><\/div><fieldset id=\"field_12_15\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >Secondary Lead Source - No<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_12_15'><div class='gchoice gchoice_12_15_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.1' type='checkbox'  value='Not a Heidi User' checked='checked' id='choice_12_15_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_15_1' id='label_12_15_1' class='gform-field-label gform-field-label--type-inline'>Not a Heidi User<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_12_16\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_12_16'>Product of Interest<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_12_16' type='text' value='Accuro AI Scribe - Powered by Heidi' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_17\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_12_17'>Lead Source<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_12_17' type='text' value='Website Leads' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_5\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_5'>Title\/Role<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_12_5' type='text' value='' class='small'    placeholder='Title\/Role *' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_3\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_3'>First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_12_3' type='text' value='' class='large'    placeholder='First Name *' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_6\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_6'>Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_12_6' type='text' value='' class='large'    placeholder='Last Name *' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_7\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_7'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_12_7' type='text' value='' class='large'    placeholder='Email *' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_8\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_8'>Clinic Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_12_8' type='text' value='' class='large'    placeholder='Clinic Name *' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_9\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_9'>Clinic Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_12_9' type='text' value='' class='large'    placeholder='Clinic Phone *' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_12\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Additional Providers<\/h3><div class='gsection_description' id='gfield_description_12_12'>Note: These are the Providers that you want individually set up. Do not simply say \u201call\u201d as each <strong>name<\/strong>, <strong>email<\/strong>, <strong>Accuro office name<\/strong> and if they are <strong>currently using Heidi<\/strong> is necessary.<\/div><\/div><fieldset id=\"field_12_10\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Additional Providers List<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Title\/Role *<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">First Name *<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Last Name *<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Email *<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Current Heidi User? (Y\/N) *<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">List the office(s) you want setup *<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_10_cell1 gform-grid-col' data-label='Title\/Role *'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_12_10\" aria-label='Title\/Role *, Row 1' data-aria-label-template='Title\/Role *, Row {0}' type='text' name='input_10[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_10_cell2 gform-grid-col' data-label='First Name *'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_12_10\" aria-label='First Name *, Row 1' data-aria-label-template='First Name *, Row {0}' type='text' name='input_10[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_10_cell3 gform-grid-col' data-label='Last Name *'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_12_10\" aria-label='Last Name *, Row 1' data-aria-label-template='Last Name *, Row {0}' type='text' name='input_10[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_10_cell4 gform-grid-col' data-label='Email *'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_12_10\" aria-label='Email *, Row 1' data-aria-label-template='Email *, Row {0}' type='text' name='input_10[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_10_cell5 gform-grid-col' data-label='Current Heidi User? (Y\/N) *'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_12_10\" aria-label='Current Heidi User? (Y\/N) *, Row 1' data-aria-label-template='Current Heidi User? (Y\/N) *, Row {0}' type='text' name='input_10[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_10_cell6 gform-grid-col' data-label='List the office(s) you want setup *'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_12_10\" aria-label='List the office(s) you want setup *, Row 1' data-aria-label-template='List the office(s) you want setup *, Row {0}' type='text' name='input_10[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 20)'>Add<\/button>   <button type='button'  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 20)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><div class='gfield_description' id='gfield_description_12_10'>Add\/Remove rows based on Providers (Max. 20). 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