{"id":111041,"date":"2016-08-17T15:42:30","date_gmt":"2016-08-17T21:42:30","guid":{"rendered":"https:\/\/93fd47b736.nxcli.net\/QIO\/?page_id=111041"},"modified":"2024-10-10T13:58:43","modified_gmt":"2024-10-10T19:58:43","slug":"success-story-submission-form","status":"publish","type":"page","link":"https:\/\/dsiohn098w.mpqhf.org\/QIO\/success-story-submission-form\/","title":{"rendered":"Success Story Submission Form"},"content":{"rendered":"<h1>We want to hear about and help share your success stories!<\/h1>\n<h2><strong>What is a success story?<\/strong><\/h2>\n<p>A success story is a description of how a person or group\u2019s effort, method, best practice or project produced a positive change. Success stories are a way to show others how good work can result in improving a person\u2019s health or in reaching health care goals.<\/p>\n<p>&nbsp;<\/p>\n<h2><strong>Share your success story and your best practices<\/strong><\/h2>\n<p>Have you put a change into action that brought about a positive outcome? Maybe there is a best practice that delivered outstanding results? Please complete the brief form below, so we can share your success and help improve the quality and delivery of health care in our communities.<\/p>\n<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_7' >\n                        <div class='gform_heading'>\n                            <p class='gform_description'>Please note: this form may time out when accessed on certain internet browsers. If you are concerned this page may time out before you are able to complete the form, or if you are unable to complete the form in one sitting, you can save your progress by clicking the \u201cSave and continue later.\u201d text at the bottom of the form.<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_7'  action='\/QIO\/wp-json\/wp\/v2\/pages\/111041' data-formid='7' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_7_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_7_1\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_7_1'>\n                            \n                            <span id='input_7_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_7_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_7_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_7_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><\/li><li id=\"field_7_2\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_7_2\" ><label class='gfield_label gform-field-label' for='input_7_2'>Organization<\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_7_2' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_7_3\" class=\"gfield gfield--type-select gfield--input-type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_7_3\" ><label class='gfield_label gform-field-label' for='input_7_3'>State<\/label><div class='ginput_container ginput_container_select'><select name='input_3' id='input_7_3' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Montana' >Montana<\/option><option value='Wyoming' >Wyoming<\/option><option value='Alaska' >Alaska<\/option><option value='Hawaii' >Hawaii<\/option><\/select><\/div><\/li><li id=\"field_7_4\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_7_4\" ><label class='gfield_label gform-field-label' for='input_7_4'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_4' id='input_7_4' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_7_5\" class=\"gfield gfield--type-phone gfield--input-type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_7_5\" ><label class='gfield_label gform-field-label' for='input_7_5'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_7_5' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_6\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_7_6\" ><label class='gfield_label gform-field-label' for='input_7_6'>Your Story<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_6' id='input_7_6' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_7_7\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox Please select &quot;I Agree&quot; to continue. gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_7_7\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Grant Permission<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_7_7'><li class='gchoice gchoice_7_7_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.1' type='checkbox'  value='I Agree'  id='choice_7_7_1'   aria-describedby=\"gfield_description_7_7\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_7_7_1' id='label_7_7_1' class='gform-field-label gform-field-label--type-inline'>I Agree<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_7_7'>I hereby grant permission to Mountain Pacific to disclose our relationship with them in quality improvement projects and to use and\/or publish information regarding this organization\u2019s quality improvement efforts, including interventions, literature, documents, images and\/or photographs, graphs, or other materials, for the purpose of furthering the advancement of healthcare quality. This is to include print, electronic, visual, verbal, Web and\/or various media for an indefinite period of time. 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Success stories are a way to show others how good work can result in improving a person\u2019s health or in reaching health care goals.<br \/>\n&nbsp;<br \/>\nShare your success story and your best practices<br \/>\nHave you put a change into action that brought about a positive outcome? Maybe there is a best practice that delivered outstanding results? Please complete the brief form below, so we can share your success and help improve the quality and delivery of health care in our communities.<\/p>\n<p>                            Please note: this form may time out when accessed on certain internet browsers. If you are concerned this page may time out before you are able to complete the form, or if you are unable to complete the form in one sitting, you can save your progress by clicking the \u201cSave and continue later.\u201d text at the bottom of the form.<\/p>\n<p>                        Name *  Required<\/p>\n<p>                                                    First<\/p>\n<p>                                                    Last<\/p>\n<p>                        Organization StateMontanaWyomingAlaskaHawaiiEmail *  Required<\/p>\n<p>                        PhoneYour Story *  RequiredGrant Permission *  Required<\/p>\n<p>\t\t\t\t\t\t\t\tI Agree<br \/>\n\t\t\t\t\t\t\tI hereby grant permission to Mountain Pacific to disclose our relationship with them in quality improvement projects and to use and\/or publish information regarding this organization\u2019s quality improvement efforts, including interventions, literature, documents, images and\/or photographs, graphs, or other materials, for the purpose of furthering the advancement of healthcare quality. This is to include print, electronic, visual, verbal, Web and\/or various media for an indefinite period of time. This release and consent is made without compensation and no compensation is required or anticipated.<br \/>\n          <a type='button' href=\"javascript:void(0);\" id='gform_save_7_footer_link' class='gform_save_link gform-theme-button gform-theme-button--secondary'  onclick='if(window[\"gf_submitting_7\"]){return false;}  if( !jQuery(\"#gform_7\")[0].checkValidity || jQuery(\"#gform_7\")[0].checkValidity()){window[\"gf_submitting_7\"]=true;} jQuery(\"#gform_save_7\").val(1); jQuery(\"#gform_7\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_7\"]){return false;} if( !jQuery(\"#gform_7\")[0].checkValidity || jQuery(\"#gform_7\")[0].checkValidity()){window[\"gf_submitting_7\"]=true;} jQuery(\"#gform_save_7\").val(1); jQuery(\"#gform_7\").trigger(\"submit\",[true]); }'> Save and continue later.<\/a><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"author":10,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_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-111041","page","type-page","status-publish","entry"],"_links":{"self":[{"href":"https:\/\/dsiohn098w.mpqhf.org\/QIO\/wp-json\/wp\/v2\/pages\/111041"}],"collection":[{"href":"https:\/\/dsiohn098w.mpqhf.org\/QIO\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dsiohn098w.mpqhf.org\/QIO\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dsiohn098w.mpqhf.org\/QIO\/wp-json\/wp\/v2\/users\/10"}],"replies":[{"embeddable":true,"href":"https:\/\/dsiohn098w.mpqhf.org\/QIO\/wp-json\/wp\/v2\/comments?post=111041"}],"version-history":[{"count":0,"href":"https:\/\/dsiohn098w.mpqhf.org\/QIO\/wp-json\/wp\/v2\/pages\/111041\/revisions"}],"wp:attachment":[{"href":"https:\/\/dsiohn098w.mpqhf.org\/QIO\/wp-json\/wp\/v2\/media?parent=111041"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}