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Security question
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Security Question
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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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"", "jsFiles": [], "label": "Your form has been saved and may be re-opened later.", "mandatory": false, "noData": true, "offset": { "lg": 0, "md": 0, "sm": 0, "xs": 0 }, "overrideParentUsRule": false, "path": "", "pathContext": "", "properties": { "floatRight": false }, "repeatingData": false, "span": { "lg": 12, "md": 12, "sm": 12, "xs": 12 }, "type": "text-display-custom" } ], [ { "_component": "saveComponent", "clearHidden": "", "entityPath": "", "exclude": false, "excludeRowData": false, "htmlLabel": "

Next steps

\n

You are required to complete these additional forms to finalize your request.

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\n
\n

Your reference code is:

\n\n

{{Form.data.SFMData.SystemProfile.TrackingCode}}

\n\n

Please note that your saved form will expire on {{data.expiryDate}}.

\n
\n
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Send yourself a reminder email

\n

Enter your email address and we'll send you you instructions on how to return to your form.

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Check your email

\n\n

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\n

If 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.

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OR

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Next steps

\n

You are required to complete these additional forms to finalize your request.

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\n
\n

Your reference code is:

\n\n

{{Form.data.SFMData.SystemProfile.TrackingCode}}

\n\n

Please quote your reference code when enquiring about your submission.

\n
\n\n
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For your records

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OR

\n\n

Send yourself an email with a PDF copy of your form

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Check your email

\n\n

We've sent a copy of your submission to {{Form.data.$submitResponse.emailSentTo ? Form.data.$submitResponse.emailSentTo : Form.data.yourEmailAddress}}.

\n\n

If you didn't receive it or would like another copy, just select the option below.

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OR

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"htmlLabel": "Save confirm", "label": "Save confirm", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "savesuccess": { "htmlLabel": "savesuccess", "label": "savesuccess", "mandatoryMsg": "", "properties": { "alertMsg": "", "leavePageWarningMessage": "", "linkWarningMsg": "opens in a new window", "mandatoryMsgSuffix": "is required", "progressMsg": "Please wait..." } }, "sendNow": { "htmlLabel": "Send now", "label": "Send now", "mandatoryMsg": "", "properties": { "fontawesome": "fa-face-laugh" } }, "sendReminderBlock": { "htmlLabel": "sendReminderBlock", "label": "sendReminderBlock", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "send_another_reminder_email": { "htmlLabel": "Send another reminder email", "label": "Send another reminder email", "mandatoryMsg": "", "properties": { "fontawesome": "fa-face-laugh" } }, "send_reminder_email": { "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" } }, "serviceFee": { "htmlLabel": "Service Fee", "label": "Service Fee", "mandatoryMsg": "" }, "smartformsLibrary": { "htmlLabel": "Smartforms Library", "label": "Smartforms Library", "mandatoryMsg": "" }, "sourceSansPro": { "htmlLabel": "Source Sans Pro", "label": "Source Sans Pro", "mandatoryMsg": "" }, "startANewForm_1": { "htmlLabel": "Start a new form", "label": "Start a new form", "mandatoryMsg": "", "properties": { "fontawesome": "fa-face-laugh" } }, "startANewForm_2": { "htmlLabel": "Start a new form", "label": "Start a new form", "mandatoryMsg": "", "properties": { "fontawesome": "fa-face-laugh" } }, "subTotal": { "htmlLabel": "Sub Total", "label": "Sub Total", "mandatoryMsg": "" }, "submissionConfirmation": { "htmlLabel": "Submission confirmation", "label": "SubmissionConfirmation", "mandatoryMsg": "", "properties": { "additionalText": "", "formName": "{{T[Form.view.id].label}}", "helpText": "", "menuText": "", "navAriaLabel": "Secondary wizard status", "sectionHeading": "{{T[Form.view.id].label}} - Submission confirmation" } }, "submit": { "htmlLabel": "Submit", "label": "Submit", "mandatoryMsg": "", "properties": { "fontawesome": "fa-face-laugh" } }, "submitComponent": { "htmlLabel": "Submit Component", "label": "Submit Success Component", "mandatoryMsg": "", "properties": { "ariaLabel": "" } }, "submitsuccess": { "htmlLabel": "", "label": "submitsuccess", "mandatoryMsg": "", "properties": { "alertMsg": "", "leavePageWarningMessage": "", "linkWarningMsg": "opens in a new window", "mandatoryMsgSuffix": "is required", "progressMsg": "Please wait..." } }, "suburblist": { "htmlLabel": "suburblist", "label": "suburblist", "mandatoryMsg": "" }, "support": { "htmlLabel": "How did the care support you and your family, or that of the patient or health consumer?", "label": "How did the care support you and your family, or that of the patient or health consumer?", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "" } }, "team": { "htmlLabel": "Name of the team you want to nominate", "label": "Name of the team you want to nominate", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "" } }, "textDisplay": { "htmlLabel": "
Security Question
\n\n

Please review your security question and answer. This question must be correctly answered to re-open the form.

\n", "label": "Security Question\n\nPlease review your security question and answer. This question must be correctly answered to re-open the form.", "mandatoryMsg": "" }, "textDisplayCustom_1": { "htmlLabel": "Thank you, your submission has been received.", "label": "Thank you, your submission has been received.", "mandatoryMsg": "" }, "textDisplayCustom_3": { "htmlLabel": "Your form has been saved and may be re-opened later.", "label": "Your form has been saved and may be re-opened later.", "mandatoryMsg": "" }, "textDisplayCustom_6": { "htmlLabel": "This will end your current session but your form will be saved and may be re-opened later.", "label": "This will end your current session but your form will be saved and may be re-opened later.", "mandatoryMsg": "" }, "textDisplayCustom_7": { "htmlLabel": "{{data.isCollab ? \"Click Confirm to continue to the next step\" : \"To resume your form please complete the following details.\"}}", "label": "", "mandatoryMsg": "" }, "textDisplay_1": { "htmlLabel": "Name of the nurse or midwife", "label": "Name of the nurse or midwife", "mandatoryMsg": "" }, "textDisplay_10": { "htmlLabel": "

Check your email

\n\n

We've sent a copy of your submission to {{Form.data.$submitResponse.emailSentTo ? Form.data.$submitResponse.emailSentTo : Form.data.yourEmailAddress}}.

\n\n

If 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": "" }, "textDisplay_11": { "htmlLabel": "

Send yourself a reminder email

\n

Enter your email address and we'll send you you instructions on how to return to your form.

", "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": "Name of the nurse", "label": "Name of the nurse", "mandatoryMsg": "" }, "textDisplay_3": { "htmlLabel": "Name of the midwife", "label": "Name of the midwife", "mandatoryMsg": "" }, "textDisplay_4": { "htmlLabel": "Please give their full name so we can identify them correctly.", "label": "Please give their full name so we can identify them correctly.", "mandatoryMsg": "" }, "textDisplay_5": { "htmlLabel": "

Check your email

\n\n

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\n

If 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": "abouttext", "label": "abouttext", "mandatoryMsg": "" }, "textDisplay_7": { "htmlLabel": "
Reference code
\n\n

{{data.isCollab?\"\":\"When you saved your form you should have been provided a reference code.\"}}

\n", "label": "Reference code", "mandatoryMsg": "" }, "textDisplay_8": { "htmlLabel": "
Security question
\n\n

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_9": { "htmlLabel": "

For your records

", "label": "For your records", "mandatoryMsg": "" }, "textdisplay1_1": { "htmlLabel": "{{data.followupdata}}", "label": "", "mandatoryMsg": "" }, "title_2": { "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": "" } }, "title_3": { "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: " } }, "type": { "htmlLabel": "Who do you want to nominate?", "label": "Who do you want to nominate?", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "options": [ { "label": "An individual", "value": "An individual" }, { "label": "A team", "value": "A team" } ], "underHelpText": "" } }, "unitvalue": { "htmlLabel": "UnitValue", "label": "UnitValue", "mandatoryMsg": "" }, "wardPhoneNumber": { "htmlLabel": "Ward phone number", "label": "Ward phone number", "mandatoryMsg": "", "properties": { "alertIcon": "fa-solid fa-face-laugh", "alertText": "", "helpText": "", "placeholder": "", "underHelpText": "" } }, "workplace": { "htmlLabel": "Workplace of the {{data.type == \"An individual\" ? \"person\" : \"team\"}} you want to nominate", "label": "Workplace of the you want to nominate", "mandatoryMsg": "", "properties": { "infoText": "" } }, "yourDetails": { "htmlLabel": "Your details", "label": "Your details", "mandatoryMsg": "", "properties": { "infoText": "" } }, "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_1": { "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" }