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Please review your security question and answer. This question must be correctly answered to re-open the form.
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", "label": "Send yourself a reminder email\nEnter your email address and we'll send you you instructions on how to return to your form.", "mandatoryMsg": "" }, "textDisplay_2": { "htmlLabel": "Please enter these details as they are shown on your current licence certificate (as shown).", "label": "Please enter these details as they are shown on your current licence certificate (as shown).", "mandatoryMsg": "" }, "textDisplay_3": { "htmlLabel": "What variations are you applying for? *", "label": "What variations are you applying for? *", "mandatoryMsg": "" }, "textDisplay_4": { "htmlLabel": "Please indicate all procedures which will be undertaken within the health care facility *", "label": "Please indicate all procedures which will be undertaken within the health care facility *", "mandatoryMsg": "" }, "textDisplay_5": { "htmlLabel": "We've sent instructions to your email address ({{Form.data.$submitResponse.emailSentTo ? Form.data.$submitResponse.emailSentTo : Form.data.send_reminder_email}}) on how to return to the application when you are ready.
\n\nIf you didn't receive it or would like a reminder sent to a different email address, just click the link below and follow the instructions.
", "label": "Check your email\n\nWe've sent instructions to your email address () on how to return to the application when you are ready.\n\nIf you didn't receive it or would like a reminder sent to a different email address, just click the link below and follow the instructions.", "mandatoryMsg": "" }, "textDisplay_6": { "htmlLabel": "{{data.isCollab?\"\":\"When you saved your form you should have been provided a reference code.\"}}
\n", "label": "Reference code", "mandatoryMsg": "" }, "textDisplay_7": { "htmlLabel": "Your answer to this question must match the information you previously provided.
\n", "label": "Security question\n\nYour answer to this question must match the information you previously provided.", "mandatoryMsg": "" }, "textDisplay_8": { "htmlLabel": "We've sent a copy of your submission to {{Form.data.$submitResponse.emailSentTo ? Form.data.$submitResponse.emailSentTo : Form.data.yourEmailAddress}}.
\n\nIf you didn't receive it or would like another copy, just select the option below.
\n", "label": "Check your email\n\nWe've sent a copy of your submission to.\n\nIf you didn't receive it or would like another copy, just select the option below.", "mandatoryMsg": "" }, "textdisplay1": { "htmlLabel": "{{data.followupdata}}", "label": "", "mandatoryMsg": "" }, "title_1": { "htmlLabel": "Title", "label": "Title", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "options": [ { "label": "Mr", "value": "Mr" }, { "label": "Mrs", "value": "Mrs" }, { "label": "Miss", "value": "Miss" }, { "label": "Ms", "value": "Ms" }, { "label": "Dr", "value": "Dr" } ], "placeholder": "", "underHelpText": "" } }, "total_1": { "htmlLabel": "Total", "label": "Total", "mandatoryMsg": "" }, "trackingCodeCustom": { "htmlLabel": "", "label": "Tracking code (Custom)", "mandatoryMsg": "", "properties": { "trackingCodePrefix": "Reference code: " } }, "trackingCodeCustom_2": { "htmlLabel": "", "label": "Tracking code (Custom)", "mandatoryMsg": "", "properties": { "trackingCodePrefix": "Reference code: " } }, "trackingCodeCustom_3": { "htmlLabel": "", "label": "Tracking code (Custom)", "mandatoryMsg": "", "properties": { "trackingCodePrefix": "Reference code: " } }, "unitSSB_5": { "htmlLabel": "Unit", "label": "Unit", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "" } }, "unitvalue": { "htmlLabel": "UnitValue", "label": "UnitValue", "mandatoryMsg": "" }, "updateBusinessCorrespondencePostalAddress": { "htmlLabel": "Update business correspondence postal address", "label": "Update business correspondence postal address", "mandatoryMsg": "", "properties": { "helpText": "" } }, "updateNSQHSAccreditationDetails": { "htmlLabel": "Update NSQHS accreditation details", "label": "Update NSQHS accreditation details", "mandatoryMsg": "", "properties": { "helpText": "" } }, "updatePatientBedDetails": { "htmlLabel": "Update patient bed details", "label": "Update patient bed details", "mandatoryMsg": "", "properties": { "helpText": "" } }, "updatePrimaryContactPersonDetails": { "htmlLabel": "Update primary contact person details", "label": "Update primary contact person details", "mandatoryMsg": "", "properties": { "helpText": "" } }, "updatePublicHealthRiskProcedures": { "htmlLabel": "Update the public health risk procedures undertaken at the facility", "label": "Update the public health risk procedures undertaken at the facility", "mandatoryMsg": "", "properties": { "helpText": "" } }, "vaginoplasty": { "htmlLabel": "Vaginoplasty", "label": "Vaginoplasty", "mandatoryMsg": "", "properties": { "helpText": "" } }, "workPhoneNumber_2": { "htmlLabel": "Work phone", "label": "Work phone", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "" } }, "yourEmailAddress": { "htmlLabel": "Your email address", "label": "Your email address", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "", "validationMessage": "Enter a valid email address e.g. name@example.com" } }, "yourSubmissionHasBeenSuccessful": { "htmlLabel": "Your submission has been successful. Please keep a copy of this receipt for your records.", "label": "Your submission has been successful. Please keep a copy of this receipt for your records.", "mandatoryMsg": "" } }, "label": "English" } ] }, "type": "form" }