(126,'nf_form_3_publishing_28','__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}],\"special_instructions\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]},\"form_field\":\"{field:high_blood_pressure_1578158450500}\",\"field_map\":\"Form__c - High Blood Pressure?\",\"special_instructions\":\"\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"salesforce_field_map\",\"type\":\"option-repeater\",\"label\":\"Salesforce Field Map <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a>\",\"width\":\"full\",\"group\":\"primary\",\"tmpl_row\":\"nf-tmpl-salesforce-custom-field-map-row\",\"value\":[],\"columns\":{\"form_field\":{\"header\":\"Form Field\",\"default\":\"\",\"options\":[]},\"field_map\":{\"header\":\"Salesforce Field\",\"default\":\"\",\"options\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}]},\"special_instructions\":{\"header\":\"Data Handling Instructions\",\"default\":\"\",\"options\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]}}}},{\"errors\":{},\"max_options\":0,\"order\":96,\"new\":false,\"options\":{\"form_field\":[],\"field_map\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}],\"special_instructions\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]},\"form_field\":\"{field:high_blood_pressure_1604626968164}\",\"field_map\":\"Form__c - High Blood Pressure?\",\"special_instructions\":\"\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"salesforce_field_map\",\"type\":\"option-repeater\",\"label\":\"Salesforce Field Map <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a>\",\"width\":\"full\",\"group\":\"primary\",\"tmpl_row\":\"nf-tmpl-salesforce-custom-field-map-row\",\"value\":[],\"columns\":{\"form_field\":{\"header\":\"Form Field\",\"default\":\"\",\"options\":[]},\"field_map\":{\"header\":\"Salesforce Field\",\"default\":\"\",\"options\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}]},\"special_instructions\":{\"header\":\"Data Handling Instructions\",\"default\":\"\",\"options\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]}}}},{\"errors\":{},\"max_options\":0,\"order\":97,\"new\":false,\"options\":{\"form_field\":[],\"field_map\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}],\"special_instructions\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]},\"form_field\":\"{field:please_specify_1605028395159}\",\"field_map\":\"Form__c - 19B Please specify\",\"special_instructions\":\"\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"salesforce_field_map\",\"type\":\"option-repeater\",\"label\":\"Salesforce Field Map <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a>\",\"width\":\"full\",\"group\":\"primary\",\"tmpl_row\":\"nf-tmpl-salesforce-custom-field-map-row\",\"value\":[],\"columns\":{\"form_field\":{\"header\":\"Form Field\",\"default\":\"\",\"options\":[]},\"field_map\":{\"header\":\"Salesforce Field\",\"default\":\"\",\"options\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}]},\"special_instructions\":{\"header\":\"Data Handling Instructions\",\"default\":\"\",\"options\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]}}}},{\"errors\":{},\"max_options\":0,\"order\":98,\"new\":false,\"options\":{\"form_field\":[],\"field_map\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}],\"special_instructions\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]},\"form_field\":\"{field:asthma_or_shortness_of_breath_1578158478661}\",\"field_map\":\"Form__c - Asthma or shortness of breath?\\\"\",\"special_instructions\":\"\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"salesforce_field_map\",\"type\":\"option-repeater\",\"label\":\"Salesforce Field Map <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a>\",\"width\":\"full\",\"group\":\"primary\",\"tmpl_row\":\"nf-tmpl-salesforce-custom-field-map-row\",\"value\":[],\"columns\":{\"form_field\":{\"header\":\"Form Field\",\"default\":\"\",\"options\":[]},\"field_map\":{\"header\":\"Salesforce Field\",\"default\":\"\",\"options\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"labe'),(127,'nf_form_3_publishing_29','l\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}]},\"special_instructions\":{\"header\":\"Data Handling Instructions\",\"default\":\"\",\"options\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]}}}},{\"errors\":{},\"max_options\":0,\"order\":99,\"new\":false,\"options\":{\"form_field\":[],\"field_map\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}],\"special_instructions\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]},\"form_field\":\"{field:asthma_or_shortness_of_breath_1604626975405}\",\"field_map\":\"Form__c - Asthma or shortness of breath?\\\"\",\"special_instructions\":\"\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"salesforce_field_map\",\"type\":\"option-repeater\",\"label\":\"Salesforce Field Map <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a>\",\"width\":\"full\",\"group\":\"primary\",\"tmpl_row\":\"nf-tmpl-salesforce-custom-field-map-row\",\"value\":[],\"columns\":{\"form_field\":{\"header\":\"Form Field\",\"default\":\"\",\"options\":[]},\"field_map\":{\"header\":\"Salesforce Field\",\"default\":\"\",\"options\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}]},\"special_instructions\":{\"header\":\"Data Handling Instructions\",\"default\":\"\",\"options\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]}}}},{\"errors\":{},\"max_options\":0,\"order\":100,\"new\":false,\"options\":{\"form_field\":[],\"field_map\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}],\"special_instructions\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]},\"form_field\":\"{field:please_specify_1605028391770}\",\"field_map\":\"Form__c - 1A\",\"special_instructions\":\"\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"salesforce_field_map\",\"type\":\"option-repeater\",\"label\":\"Salesforce Field Map <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a>\",\"width\":\"full\",\"group\":\"primary\",\"tmpl_row\":\"nf-tmpl-salesforce-custom-field-map-row\",\"value\":[],\"columns\":{\"form_field\":{\"header\":\"Form Field\",\"default\":\"\",\"options\":[]},\"field_map\":{\"header\":\"Salesforce Field\",\"default\":\"\",\"options\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}]},\"special_instructions\":{\"header\":\"Data Handling Instructions\",\"default\":\"\",\"options\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]}}}},{\"errors\":{},\"max_options\":0,\"order\":101,\"new\":false,\"options\":{\"form_field\":[],\"field_map\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}],\"special_instructions\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]},\"form_field\":\"{field:obstructive_sleep_apnea_1600215661727}\",\"field_map\":\"Form__c - Obstructive sleep apnea?\",\"special_instructions\":\"\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"salesforce_field_map\",\"type\":\"option-repeater\",\"label\":\"Salesforce Field Map <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a>\",\"width\":\"full\",\"group\":\"primary\",\"tmpl_row\":\"nf-tmpl-salesforce-custom-field-map-row\",\"value\":[],\"columns\":{\"form_field\":{\"header\":\"Form Field\",\"default\":\"\",\"options\":[]},\"field_map\":{\"header\":\"Salesforce Field\",\"default\":\"\",\"options\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please spe'),(128,'nf_form_3_publishing_30','cify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}]},\"special_instructions\":{\"header\":\"Data Handling Instructions\",\"default\":\"\",\"options\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]}}}},{\"errors\":{},\"max_options\":0,\"order\":102,\"new\":false,\"options\":{\"form_field\":[],\"field_map\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}],\"special_instructions\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]},\"form_field\":\"{field:obstructive_sleep_apnea_1604626982889}\",\"field_map\":\"Form__c - Obstructive sleep apnea?\",\"special_instructions\":\"\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"salesforce_field_map\",\"type\":\"option-repeater\",\"label\":\"Salesforce Field Map <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a>\",\"width\":\"full\",\"group\":\"primary\",\"tmpl_row\":\"nf-tmpl-salesforce-custom-field-map-row\",\"value\":[],\"columns\":{\"form_field\":{\"header\":\"Form Field\",\"default\":\"\",\"options\":[]},\"field_map\":{\"header\":\"Salesforce Field\",\"default\":\"\",\"options\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}]},\"special_instructions\":{\"header\":\"Data Handling Instructions\",\"default\":\"\",\"options\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]}}}},{\"errors\":{},\"max_options\":0,\"order\":103,\"new\":false,\"options\":{\"form_field\":[],\"field_map\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}],\"special_instructions\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]},\"form_field\":\"{field:please_specify_1604626989398}\",\"field_map\":\"Form__c - 1B\",\"special_instructions\":\"\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"salesforce_field_map\",\"type\":\"option-repeater\",\"label\":\"Salesforce Field Map <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a>\",\"width\":\"full\",\"group\":\"primary\",\"tmpl_row\":\"nf-tmpl-salesforce-custom-field-map-row\",\"value\":[],\"columns\":{\"form_field\":{\"header\":\"Form Field\",\"default\":\"\",\"options\":[]},\"field_map\":{\"header\":\"Salesforce Field\",\"default\":\"\",\"options\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}]},\"special_instructions\":{\"header\":\"Data Handling Instructions\",\"default\":\"\",\"options\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]}}}},{\"errors\":{},\"max_options\":0,\"order\":104,\"new\":false,\"options\":{\"form_field\":[],\"field_map\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}],\"special_instructions\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]},\"form_field\":\"{field:pregnancy_1578158506066}\",\"field_map\":\"Form__c - Pregnancy\",\"special_instructions\":\"\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"salesforce_field_map\",\"type\":\"option-repeater\",\"label\":\"Salesforce Field Map <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a>\",\"width\":\"full\",\"group\":\"primary\",\"tmpl_row\":\"nf-tmpl-salesforce-custom-field-map-row\",\"value\":[],\"columns\":{\"form_field\":{\"header\":\"Form Field\",\"default\":\"\",\"options\":[]},\"field_map\":{\"header\":\"Salesforce Field\",\"default\":\"\",\"options\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}]},\"special_instructions\":{\"header\":\"Data Handling Instructions\",\"default\":\"\",\"options\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]}}}},{\"errors\":{},\"max_options\":0,\"order\":105,\"new\":false,\"options\":{\"form_field\":[],\"field_map\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Cli'),(147,'nf_form_3_publishing_31','ck Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}],\"special_instructions\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]},\"form_field\":\"{field:pregnancy_1604626996778}\",\"field_map\":\"Form__c - Pregnancy\",\"special_instructions\":\"\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"salesforce_field_map\",\"type\":\"option-repeater\",\"label\":\"Salesforce Field Map <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a>\",\"width\":\"full\",\"group\":\"primary\",\"tmpl_row\":\"nf-tmpl-salesforce-custom-field-map-row\",\"value\":[],\"columns\":{\"form_field\":{\"header\":\"Form Field\",\"default\":\"\",\"options\":[]},\"field_map\":{\"header\":\"Salesforce Field\",\"default\":\"\",\"options\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}]},\"special_instructions\":{\"header\":\"Data Handling Instructions\",\"default\":\"\",\"options\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]}}}},{\"errors\":{},\"max_options\":0,\"order\":106,\"new\":false,\"options\":{\"form_field\":[],\"field_map\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}],\"special_instructions\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]},\"form_field\":\"{field:please_specify_1605028384580}\",\"field_map\":\"Form__c - Pleasespecify7B\",\"special_instructions\":\"\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"salesforce_field_map\",\"type\":\"option-repeater\",\"label\":\"Salesforce Field Map <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a>\",\"width\":\"full\",\"group\":\"primary\",\"tmpl_row\":\"nf-tmpl-salesforce-custom-field-map-row\",\"value\":[],\"columns\":{\"form_field\":{\"header\":\"Form Field\",\"default\":\"\",\"options\":[]},\"field_map\":{\"header\":\"Salesforce Field\",\"default\":\"\",\"options\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Form\",\"value\":\"Form__c - Form\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"}]},\"special_instructions\":{\"header\":\"Data Handling Instructions\",\"default\":\"\",\"options\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]}}}}],\"drawerDisabled\":false},\"id\":68}],\"settings\":{\"objectType\":\"Form Setting\",\"editActive\":true,\"title\":\"Questionnaire \",\"created_at\":\"2020-01-03 11:12:24\",\"default_label_pos\":\"hidden\",\"show_title\":0,\"clear_complete\":\"1\",\"hide_complete\":\"1\",\"logged_in\":\"\",\"key\":\"\",\"conditions\":[{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"have_you_ever_received_psychiatric_treatment_1605028278678\",\"comparator\":\"equal\",\"value\":\"Yes\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"have_you_ever_received_psychiatric_treatment_1605028478761\",\"trigger\":\"show_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[{\"key\":\"have_you_ever_received_psychiatric_treatment_1605028478761\",\"trigger\":\"hide_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"else\"}]},{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"prior_suicide_attempts_1604626774735\",\"comparator\":\"equal\",\"value\":\"Yes\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"if_so_when_1605028474098\",\"trigger\":\"show_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[{\"key\":\"if_so_when_1605028474098\",\"trigger\":\"hide_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"else\"}]},{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"allergies_medications_food_etc_1604626818638\",\"comparator\":\"equal\",\"value\":\"Yes\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"please_specify_and_describe_reactions_1605028468607\",\"trigger\":\"show_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[{\"key\":\"please_specify_and_describe_reactions_1605028468607\",\"trigger\":\"hide_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"else\"}]},{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"past_surgeries_1604626829769\",\"comparator\":\"equal\",\"value\":\"Yes\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"please_specify_1604626840869\",\"trigger\":\"show_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[{\"key\":\"please_specify_1604626840869\",\"trigger\":\"hide_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"else\"}]},{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"hospitalization_in_the_last_two_years_1604626847682\",\"comparator\":\"equal\",\"value\":\"Yes\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"please_specify_1605028454194\",\"trigger\":\"show_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[{\"key\":\"please_specify_1605028454194\",\"trigger\":\"hide_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"else\"}]},{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"adverse_reactions_to_anesthesia_in_the_past_1604626862675\",\"comparator\":\"equal\",\"value\":\"Yes\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"please_specify_1604626870073\",\"trigger\":\"show_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[{\"key\":\"please_specify_1604626870073\",\"trigger\":\"hide_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"else\"}]},{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"emergency_room_visits_in_the_last_year_1604626878917\",\"comparator\":\"equal\",\"value\":\"Yes\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"please_specify_1605028446080\",\"trigger\":\"show_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[{\"key\":\"please_specify_1605028446080\",\"trigger\":\"hide_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"else\"}]},{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"accidents_work_car_etc_1604626892890\",\"comparator\":\"equal\",\"value\":\"Yes\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"please_specify_1605028440842\",\"trigger\":\"show_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[{\"key\":\"please_specify_1605028440842\",\"trigger\":\"hide_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"else\"}]},{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"head_injuries_1604626901734\",\"comparator\":\"equal\",\"value\":\"Yes\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"please_specify_1605028434378\",\"trigger\":\"show_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[{\"key\":\"please_specify_1605028434378\",\"trigger\":\"hide_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"else\"}]},{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"loss_of_consciousness_1604626910610\",\"comparator\":\"equal\",\"value\":\"Yes\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"please_specify_1605028429848\",\"trigger\":\"show_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[{\"key\":\"please_specify_1605028429848\",\"trigger\":\"hide_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"else\"}]},{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"loss_of_consciousness_seizures_1604626915727\",\"comparator\":\"equal\",\"value\":\"Yes\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"please_specify_1605028424388\",\"trigger\":\"show_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[{\"key\":\"please_specify_1605028424388\",\"trigger\":\"hide_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"else\"}]},{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"heart_disease_1604626922511\",\"comparator\":\"equal\",\"value\":\"Yes\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"please_specify_1605028421382\",\"trigger\":\"show_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[{\"key\":\"please_specify_1605028421382\",\"trigger\":\"hide_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"else\"}]},{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"lung_disease_1604626931227\",\"comparator\":\"equal\",\"value\":\"Yes\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"please_specify_1605028416339\",\"trigger\":\"show_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[{\"key\":\"please_specify_1605028416339\",\"trigger\":\"hide_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"else\"}]},{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"liver_disease_infections_1604626937884\",\"comparator\":\"equal\",\"value\":\"Yes\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"please_specify_1605028412732\",\"trigger\":\"show_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[{\"key\":\"please_specify_1605028412732\",\"trigger\":\"hide_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"else\"}]},{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"kidney_disease_problem_1604626946354\",\"comparator\":\"equal\",\"value\":\"Yes\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"please_specify_1605028409028\",\"trigger\":\"show_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[{\"key\":\"please_specify_1605028409028\",\"trigger\":\"hide_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"else\"}]},{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"diabetes_1604626953114\",\"comparator\":\"equal\",\"value\":\"Yes\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"please_specify_1605028404243\",\"trigger\":\"show_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[{\"key\":\"please_specify_1605028404243\",\"trigger\":\"hide_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"else\"}]},{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"ulcers_1604626961086\",\"comparator\":\"equal\",\"value\":\"Yes\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"please_specify_1605028399616\",\"trigger\":\"show_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[{\"key\":\"please_specify_1605028399616\",\"trigger\":\"hide_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"else\"}]},{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"high_blood_pressure_1604626968164\",\"comparator\":\"equal\",\"value\":\"Yes\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"please_specify_1605028395159\",\"trigger\":\"show_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[{\"key\":\"please_specify_1605028395159\",\"trigger\":\"hide_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"else\"}]},{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"asthma_or_shortness_of_breath_1604626975405\",\"comparator\":\"equal\",\"value\":\"Yes\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"please_specify_1605028391770\",\"trigger\":\"show_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[{\"key\":\"please_specify_1605028391770\",\"trigger\":\"hide_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"else\"}]},{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"obstructive_sleep_apnea_1604626982889\",\"comparator\":\"equal\",\"value\":\"Yes\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"please_specify_1604626989398\",\"trigger\":\"show_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[{\"key\":\"please_specify_1604626989398\",\"trigger\":\"hide_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"else\"}]},{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"pregnancy_1604626996778\",\"comparator\":\"equal\",\"value\":\"Yes\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"please_specify_1605028384580\",\"trigger\":\"show_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[{\"key\":\"please_specify_1605028384580\",\"trigger\":\"hide_field\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"else\"}]}],\"wrapper_class\":\"questionnaire\",\"element_class\":\"questionnaire\",\"add_submit\":\"1\",\"not_logged_in_msg\":\"\",\"sub_limit_number\":\"\",\"sub_limit_msg\":\"\",\"calculations\":[],\"formContentData\":[{\"order\":1,\"cells\":[{\"order\":0,\"fields\":[\"html_1578075230040\"],\"width\":\"100\"}]},{\"order\":2,\"cells\":[{\"order\":0,\"fields\":[\"first_and_last_name_1578264011106\"],\"width\":\"100\"}]},{\"order\":3,\"cells\":[{\"order\":0,\"fields\":[\"date_of_birth_1608133712835\"],\"width\":\"100\"}]},{\"order\":4,\"cells\":[{\"order\":0,\"fields\":[\"dob_-_month_1608133347247\"],\"width\":42},{\"order\":1,\"fields\":[\"dob_-_day_1608133338513\"],\"width\":25},{\"order\":2,\"fields\":[\"dob_-_year_1608133331165\"],\"width\":33}]},{\"order\":5,\"cells\":[{\"order\":0,\"fields\":[\"social_security_1578075394788\"],\"width\":\"100\"}]},{\"order\":6,\"cells\":[{\"order\":0,\"fields\":[\"preferred_language_1578075436194\"],\"width\":\"100\"}]},{\"order\":7,\"cells\":[{\"order\":0,\"fields\":[\"sex_1579144225984\"],\"width\":50},{\"order\":1,\"fields\":[\"marital_status_1579144232369\"],\"width\":50}]},{\"order\":8,\"cells\":[{\"order\":0,\"fields\":[\"sex_1578075483082\"],\"width\":50},{\"order\":1,\"fields\":[\"marital_status_1578075530403\"],\"width\":50}]},{\"order\":9,\"cells\":[{\"order\":0,\"fields\":[\"race_1578075709089\"],\"width\":50},{\"order\":1,\"fields\":[\"ethnicity_1578075730495\"],\"width\":50}]},{\"order\":10,\"cells\":[{\"order\":0,\"fields\":[\"preferred_pharmacy_1578075757751\"],\"width\":50},{\"order\":1,\"fields\":[\"location_1578075778740\"],\"width\":50}]},{\"order\":11,\"cells\":[{\"order\":0,\"fields\":[\"primary_care_doctor_1592336142626\"],\"width\":50},{\"order\":1,\"fields\":[\"phone_1592336104911\"],\"width\":50}]},{\"order\":12,\"cells\":[{\"order\":0,\"fields\":[\"weight_1601424804490\"],\"width\":50},{\"order\":1,\"fields\":[\"height_1601424815358\"],\"width\":50}]},{\"order\":13,\"cells\":[{\"order\":0,\"fields\":[\"address_1578075894927\"],\"width\":\"100\"}]},{\"order\":14,\"cells\":[{\"order\":0,\"fields\":[\"street_1578075919537\"],\"width\":50},{\"order\":1,\"fields\":[\"city_1578075946838\"],\"width\":50}]},{\"order\":15,\"cells\":[{\"order\":0,\"fields\":[\"state_1578075979677\"],\"width\":50},{\"order\":1,\"fields\":[\"zip_1578076001050\"],\"width\":50}]},{\"order\":16,\"cells\":[{\"order\":0,\"fields\":[\"listcountry_1578076020448\"],\"width\":\"100\"}]},{\"order\":17,\"cells\":[{\"order\":0,\"fields\":[\"primary_phone_1578076148286\"],\"width\":50},{\"order\":1,\"fields\":[\"email_1578076138596\"],\"width\":50}]},{\"order\":18,\"cells\":[{\"order\":0,\"fields\":[\"alternate_phone_1578076168968\"],\"width\":50},{\"order\":1,\"fields\":[\"occupation_1578076203903\"],\"width\":50}]},{\"order\":19,\"cells\":[{\"order\":0,\"fields\":[\"emergency_contact_1578076287807\"],\"width\":\"100\"}]},{\"order\":20,\"cells\":[{\"order\":0,\"fields\":[\"first_and_last_name_-_emergency_1578278068350\"],\"width\":50},{\"order\":1,\"fields\":[\"relationship_to_patient_1578076336070\"],\"width\":50}]},{\"order\":21,\"cells\":[{\"order\":0,\"fields\":[\"email_1578076990429\"],\"width\":50},{\"order\":1,\"fields\":[\"phone_1578076995323\"],\"width\":50}]},{\"order\":22,\"cells\":[{\"order\":0,\"fields\":[\"other_relevant_personal_remarks_1578077914615\"],\"width\":\"100\"}]},{\"order\":23,\"cells\":[{\"order\":0,\"fields\":[\"drugs_currently_being_used_1578077982648\"],\"width\":\"100\"}]},{\"order\":24,\"cells\":[{\"order\":0,\"fields\":[\"drug_name_1578078011173\"],\"width\":33},{\"order\":1,\"fields\":[\"amount_per_day_1578078060929\"],\"width\":33},{\"order\":2,\"fields\":[\"method_of_use_1578078084672\"],\"width\":33}]},{\"order\":25,\"cells\":[{\"order\":0,\"fields\":[\"drug_name_1579144301678\"],\"width\":33},{\"order\":1,\"fields\":[\"amount_per_day_1579144303596\"],\"width\":33},{\"order\":2,\"fields\":[\"method_of_use_1579144305445\"],\"width\":33}]},{\"order\":26,\"cells\":[{\"order\":0,\"fields\":[\"drug_name_1579144308203\"],\"width\":33},{\"order\":1,\"fields\":[\"amount_per_day_1579144311011\"],\"width\":33},{\"order\":2,\"fields\":[\"method_of_use_1579144315957\"],\"width\":33}]},{\"order\":27,\"cells\":[{\"order\":0,\"fields\":[\"most_recent_attempt_to_withdraw_1578078194451\"],\"width\":\"100\"}]},{\"order\":28,\"cells\":[{\"order\":0,\"fields\":[\"institution_or_clinic_1578078230606\"],\"width\":50},{\"order\":1,\"fields\":[\"date_1578078219288\"],\"width\":50}]},{\"order\":29,\"cells\":[{\"order\":0,\"fields\":[\"general_remarks_about_your_withdrawal_attempts_1578078300616\"],\"width\":\"100\"}]},{\"order\":30,\"cells\":[{\"order\":0,\"fields\":[\"craving_scale_while_clean_1578078360440\"],\"width\":\"100\"}]},{\"order\":31,\"cells\":[{\"order\":0,\"fields\":[\"craving_scale_while_clean_1604626729158\"],\"width\":\"100\"}]},{\"order\":32,\"cells\":[{\"order\":0,\"fields\":[\"please_specify_1578078449997\"],\"width\":\"100\"}]},{\"order\":33,\"cells\":[{\"order\":0,\"fields\":[\"methadone_or_suboxone_maintenance_1578078498160\"],\"width\":\"100\"}]},{\"order\":34,\"cells\":[{\"order\":0,\"fields\":[\"methadone_or_suboxone_maintenance_1604626740655\"],\"width\":\"100\"}]},{\"order\":35,\"cells\":[{\"order\":0,\"fields\":[\"for_how_long_1578078562189\"],\"width\":\"100\"}]},{\"order\":36,\"cells\":[{\"order\":0,\"fields\":[\"have_you_ever_received_psychiatric_treatment_1578157298340\"],\"width\":\"100\"}]},{\"order\":37,\"cells\":[{\"order\":0,\"fields\":[\"have_you_ever_received_psychiatric_treatment_1605028278678\"],\"width\":\"100\"}]},{\"order\":38,\"cells\":[{\"order\":0,\"fields\":[\"have_you_ever_received_psychiatric_treatment_1605028478761\"],\"width\":\"100\"}]},{\"order\":39,\"cells\":[{\"order\":0,\"fields\":[\"prior_suicide_attempts_1578157378656\"],\"width\":\"100\"}]},{\"order\":40,\"cells\":[{\"order\":0,\"fields\":[\"prior_suicide_attempts_1604626774735\"],\"width\":\"100\"}]},{\"order\":41,\"cells\":[{\"order\":0,\"fields\":[\"if_so_when_1605028474098\"],\"width\":\"100\"}]},{\"order\":42,\"cells\":[{\"order\":0,\"fields\":[\"past_medical_history_1578157460028\"],\"width\":\"100\"}]},{\"order\":43,\"cells\":[{\"order\":0,\"fields\":[\"medication_1578157508064\"],\"width\":25},{\"order\":1,\"fields\":[\"dose_1578157528462\"],\"width\":25},{\"order\":2,\"fields\":[\"frequency_1578157549166\"],\"width\":25},{\"order\":3,\"fields\":[\"route_1578157564661\"],\"width\":25}]},{\"order\":45,\"cells\":[{\"order\":0,\"fields\":[\"medication_1579144360190\"],\"width\":25},{\"order\":1,\"fields\":[\"dose_1579144361917\"],\"width\":25},{\"order\":2,\"fields\":[\"frequency_1579144363542\"],\"width\":25},{\"order\":3,\"fields\":[\"route_1579144365291\"],\"width\":25}]},{\"order\":49,\"cells\":[{\"order\":0,\"fields\":[\"medication_1579144368046\"],\"width\":25},{\"order\":1,\"fields\":[\"dose_1579144371110\"],\"width\":25},{\"order\":2,\"fields\":[\"frequency_1579144375388\"],\"width\":25},{\"order\":3,\"fields\":[\"route_1579144378724\"],\"width\":25}]},{\"order\":53,\"cells\":[{\"order\":0,\"fields\":[\"allergies_medications_food_etc_1578157776065\"],\"width\":\"100\"}]},{\"order\":54,\"cells\":[{\"order\":0,\"fields\":[\"allergies_medications_food_etc_1604626818638\"],\"width\":\"100\"}]},{\"order\":55,\"cells\":[{\"order\":0,\"fields\":[\"please_specify_and_describe_reactions_1605028468607\"],\"width\":\"100\"}]},{\"order\":56,\"cells\":[{\"order\":0,\"fields\":[\"past_surgeries_1578157846236\"],\"width\":\"100\"}]},{\"order\":57,\"cells\":[{\"order\":0,\"fields\":[\"past_surgeries_1604626829769\"],\"width\":\"100\"}]},{\"order\":58,\"cells\":[{\"order\":0,\"fields\":[\"please_specify_1604626840869\"],\"width\":\"100\"}]},{\"order\":59,\"cells\":[{\"order\":0,\"fields\":[\"hospitalization_in_the_last_two_years_1578157907919\"],\"width\":\"100\"}]},{\"order\":60,\"cells\":[{\"order\":0,\"fields\":[\"hospitalization_in_the_last_two_years_1604626847682\"],\"width\":\"100\"}]},{\"order\":61,\"cells\":[{\"order\":0,\"fields\":[\"please_specify_1605028454194\"],\"width\":\"100\"}]},{\"order\":62,\"cells\":[{\"order\":0,\"fields\":[\"adverse_reactions_to_anesthesia_in_the_past_1600215456184\"],\"width\":\"100\"}]},{\"order\":63,\"cells\":[{\"order\":0,\"fields\":[\"adverse_reactions_to_anesthesia_in_the_past_1604626862675\"],\"width\":\"100\"}]},{\"order\":64,\"cells\":[{\"order\":0,\"fields\":[\"please_specify_1604626870073\"],\"width\":\"100\"}]},{\"order\":65,\"cells\":[{\"order\":0,\"fields\":[\"emergency_room_visits_in_the_last_year_1578157973740\"],\"width\":\"100\"}]},{\"order\":66,\"cells\":[{\"order\":0,\"fields\":[\"emergency_room_visits_in_the_last_year_1604626878917\"],\"width\":\"100\"}]},{\"order\":67,\"cells\":[{\"order\":0,\"fields\":[\"please_specify_1605028446080\"],\"width\":\"100\"}]},{\"order\":68,\"cells\":[{\"order\":0,\"fields\":[\"accidents_work_car_etc_1578158004941\"],\"width\":\"100\"}]},{\"order\":69,\"cells\":[{\"order\":0,\"fields\":[\"accidents_work_car_etc_1604626892890\"],\"width\":\"100\"}]},{\"order\":70,\"cells\":[{\"order\":0,\"fields\":[\"please_specify_1605028440842\"],\"width\":\"100\"}]},{\"order\":71,\"cells\":[{\"order\":0,\"fields\":[\"head_injuries_1578158063175\"],\"width\":\"100\"}]},{\"order\":72,\"cells\":[{\"order\":0,\"fields\":[\"head_injuries_1604626901734\"],\"width\":\"100\"}]},{\"order\":73,\"cells\":[{\"order\":0,\"fields\":[\"please_specify_1605028434378\"],\"width\":\"100\"}]},{\"order\":74,\"cells\":[{\"order\":0,\"fields\":[\"loss_of_consciousness_1578158095789\"],\"width\":\"100\"}]},{\"order\":75,\"cells\":[{\"order\":0,\"fields\":[\"loss_of_consciousness_1604626910610\"],\"width\":\"100\"}]},{\"order\":76,\"cells\":[{\"order\":0,\"fields\":[\"please_specify_1605028429848\"],\"width\":\"100\"}]},{\"order\":77,\"cells\":[{\"order\":0,\"fields\":[\"loss_of_consciousness_seizures_1579144452405\"],\"width\":\"100\"}]},{\"order\":78,\"cells\":[{\"order\":0,\"fields\":[\"loss_of_consciousness_seizures_1604626915727\"],\"width\":\"100\"}]},{\"order\":79,\"cells\":[{\"order\":0,\"fields\":[\"please_specify_1605028424388\"],\"width\":\"100\"}]},{\"order\":80,\"cells\":[{\"order\":0,\"fields\":[\"heart_disease_1578158190955\"],\"width\":\"100\"}]},{\"order\":81,\"cells\":[{\"order\":0,\"fields\":[\"heart_disease_1604626922511\"],\"width\":\"100\"}]},{\"order\":82,\"cells\":[{\"order\":0,\"fields\":[\"please_specify_1605028421382\"],\"width\":\"100\"}]},{\"order\":83,\"cells\":[{\"order\":0,\"fields\":[\"lung_disease_1578158224175\"],\"width\":\"100\"}]},{\"order\":84,\"cells\":[{\"order\":0,\"fields\":[\"lung_disease_1604626931227\"],\"width\":\"100\"}]},{\"order\":85,\"cells\":[{\"order\":0,\"fields\":[\"please_specify_1605028416339\"],\"width\":\"100\"}]},{\"order\":86,\"cells\":[{\"order\":0,\"fields\":[\"liver_disease_infections_1578158255415\"],\"width\":\"100\"}]},{\"order\":87,\"cells\":[{\"order\":0,\"fields\":[\"liver_disease_infections_1604626937884\"],\"width\":\"100\"}]},{\"order\":88,\"cells\":[{\"order\":0,\"fields\":[\"please_specify_1605028412732\"],\"width\":\"100\"}]},{\"order\":89,\"cells\":[{\"order\":0,\"fields\":[\"kidney_disease_problem_1578158304108\"],\"width\":\"100\"}]},{\"order\":90,\"cells\":[{\"order\":0,\"fields\":[\"kidney_disease_problem_1604626946354\"],\"width\":\"100\"}]},{\"order\":91,\"cells\":[{\"order\":0,\"fields\":[\"please_specify_1605028409028\"],\"width\":\"100\"}]},{\"order\":92,\"cells\":[{\"order\":0,\"fields\":[\"diabetes_1578158392415\"],\"width\":\"100\"}]},{\"order\":93,\"cells\":[{\"order\":0,\"fields\":[\"diabetes_1604626953114\"],\"width\":\"100\"}]},{\"order\":94,\"cells\":[{\"order\":0,\"fields\":[\"please_specify_1605028404243\"],\"width\":\"100\"}]},{\"order\":95,\"cells\":[{\"order\":0,\"fields\":[\"ulcers_1578158420889\"],\"width\":\"100\"}]},{\"order\":96,\"cells\":[{\"order\":0,\"fields\":[\"ulcers_1604626961086\"],\"width\":\"100\"}]},{\"order\":97,\"cells\":[{\"order\":0,\"fields\":[\"please_specify_1605028399616\"],\"width\":\"100\"}]},{\"order\":98,\"cells\":[{\"order\":0,\"fields\":[\"high_blood_pressure_1578158450500\"],\"width\":\"100\"}]},{\"order\":99,\"cells\":[{\"order\":0,\"fields\":[\"high_blood_pressure_1604626968164\"],\"width\":\"100\"}]},{\"order\":100,\"cells\":[{\"order\":0,\"fields\":[\"please_specify_1605028395159\"],\"width\":\"100\"}]},{\"order\":101,\"cells\":[{\"order\":0,\"fields\":[\"asthma_or_shortness_of_breath_1578158478661\"],\"width\":\"100\"}]},{\"order\":102,\"cells\":[{\"order\":0,\"fields\":[\"asthma_or_shortness_of_breath_1604626975405\"],\"width\":\"100\"}]},{\"order\":103,\"cells\":[{\"order\":0,\"fields\":[\"please_specify_1605028391770\"],\"width\":\"100\"}]},{\"order\":104,\"cells\":[{\"order\":0,\"fields\":[\"obstructive_sleep_apnea_1600215661727\"],\"width\":\"100\"}]},{\"order\":105,\"cells\":[{\"order\":0,\"fields\":[\"obstructive_sleep_apnea_1604626982889\"],\"width\":\"100\"}]},{\"order\":106,\"cells\":[{\"order\":0,\"fields\":[\"please_specify_1604626989398\"],\"width\":\"100\"}]},{\"order\":107,\"cells\":[{\"order\":0,\"fields\":[\"pregnancy_1578158506066\"],\"width\":\"100\"}]},{\"order\":108,\"cells\":[{\"order\":0,\"fields\":[\"pregnancy_1604626996778\"],\"width\":\"100\"}]},{\"order\":109,\"cells\":[{\"order\":0,\"fields\":[\"please_specify_1605028384580\"],\"width\":\"100\"}]},{\"order\":110,\"cells\":[{\"order\":0,\"fields\":[\"submit_1578158786744\"],\"width\":\"100\"}]}],\"currency\":\"\",\"unique_field_error\":\"A form with this value has already been submitted.\",\"container_styles_background-color\":\"\",\"container_styles_border\":\"\",\"container_styles_border-style\":\"\",\"container_styles_border-color\":\"\",\"container_styles_color\":\"\",\"container_styles_height\":\"\",\"container_styles_width\":\"\",\"container_styles_font-size\":\"\",\"container_styles_margin\":\"\",\"container_styles_padding\":\"\",\"container_styles_display\":\"\",\"container_styles_float\":\"\",\"container_styles_show_advanced_css\":\"0\",\"container_styles_advanced\":\"\",\"title_styles_background-color\":\"\",\"title_styles_border\":\"\",\"title_styles_border-style\":\"\",\"title_styles_border-color\":\"\",\"title_styles_color\":\"\",\"title_styles_height\":\"\",\"title_styles_width\":\"\",\"title_styles_font-size\":\"\",\"title_styles_margin\":\"\",\"title_styles_padding\":\"\",\"title_styles_display\":\"\",\"title_styles_float\":\"\",\"title_styles_show_advanced_css\":\"0\",\"title_styles_advanced\":\"\",\"row_styles_background-color\":\"\",\"row_styles_border\":\"\",\"row_styles_border-style\":\"\",\"row_styles_border-color\":\"\",\"row_styles_color\":\"\",\"row_styles_height\":\"\",\"row_styles_width\":\"\",\"row_styles_font-size\":\"\",\"row_styles_margin\":\"\",\"row_styles_padding\":\"\",\"row_styles_display\":\"\",\"row_styles_show_advanced_css\":\"0\",\"row_styles_advanced\":\"\",\"row-odd_styles_background-color\":\"\",\"row-odd_styles_border\":\"\",\"row-odd_styles_border-style\":\"\",\"row-odd_styles_border-color\":\"\",\"row-odd_styles_color\":\"\",\"row-odd_styles_height\":\"\",\"row-odd_styles_width\":\"\",\"row-odd_styles_font-size\":\"\",\"row-odd_styles_margin\":\"\",\"row-odd_styles_padding\":\"\",\"row-odd_styles_display\":\"\",\"row-odd_styles_show_advanced_css\":\"0\",\"row-odd_styles_advanced\":\"\",\"success-msg_styles_background-color\":\"\",\"success-msg_styles_border\":\"\",\"success-msg_styles_border-style\":\"\",\"success-msg_styles_border-color\":\"\",\"success-msg_styles_color\":\"\",\"success-msg_styles_height\":\"\",\"success-msg_styles_width\":\"\",\"success-msg_styles_font-size\":\"\",\"success-msg_styles_margin\":\"\",\"success-msg_styles_padding\":\"\",\"success-msg_styles_display\":\"\",\"success-msg_styles_show_advanced_css\":\"0\",\"success-msg_styles_advanced\":\"\",\"error_msg_styles_background-color\":\"\",\"error_msg_styles_border\":\"\",\"error_msg_styles_border-style\":\"\",\"error_msg_styles_border-color\":\"\",\"error_msg_styles_color\":\"\",\"error_msg_styles_height\":\"\",\"error_msg_styles_width\":\"\",\"error_msg_styles_font-size\":\"\",\"error_msg_styles_margin\":\"\",\"error_msg_styles_padding\":\"\",\"error_msg_styles_display\":\"\",\"error_msg_styles_show_advanced_css\":\"0\",\"error_msg_styles_advanced\":\"\",\"allow_public_link\":0,\"embed_form\":\"\",\"changeEmailErrorMsg\":\"\",\"changeDateErrorMsg\":\"\",\"confirmFieldErrorMsg\":\"\",\"fieldNumberNumMinError\":\"\",\"fieldNumberNumMaxError\":\"\",\"fieldNumberIncrementBy\":\"\",\"formErrorsCorrectErrors\":\"\",\"validateRequiredField\":\"\",\"honeypotHoneypotError\":\"\",\"fieldsMarkedRequired\":\"required\",\"drawerDisabled\":false},\"deleted_fields\":{},\"deleted_actions\":{}}'),(151,'nf_form_1_publishing_0','{\"id\":1,\"show_publish_options\":false,\"fields\":[{\"settings\":{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":1,\"label\":\"\",\"key\":\"name_1592252414561\",\"type\":\"textbox\",\"created_at\":\"2019-12-30 21:26:55\",\"label_pos\":\"above\",\"required\":\"1\",\"placeholder\":\"Name *\",\"default\":\"\",\"wrapper_class\":\"\",\"element_class\":\"\",\"container_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"wrap_styles_background-color\":\"\",\"wrap_styles_border\":\"\",\"wrap_styles_border-style\":\"\",\"wrap_styles_border-color\":\"\",\"wrap_styles_color\":\"\",\"wrap_styles_height\":\"\",\"wrap_styles_width\":\"\",\"wrap_styles_font-size\":\"\",\"wrap_styles_margin\":\"\",\"wrap_styles_padding\":\"\",\"wrap_styles_display\":\"\",\"wrap_styles_float\":\"\",\"wrap_styles_show_advanced_css\":\"0\",\"wrap_styles_advanced\":\"\",\"label_styles_background-color\":\"\",\"label_styles_border\":\"\",\"label_styles_border-style\":\"\",\"label_styles_border-color\":\"\",\"label_styles_color\":\"\",\"label_styles_height\":\"\",\"label_styles_width\":\"\",\"label_styles_font-size\":\"\",\"label_styles_margin\":\"\",\"label_styles_padding\":\"\",\"label_styles_display\":\"\",\"label_styles_float\":\"\",\"label_styles_show_advanced_css\":\"0\",\"label_styles_advanced\":\"\",\"element_styles_background-color\":\"\",\"element_styles_border\":\"\",\"element_styles_border-style\":\"\",\"element_styles_border-color\":\"\",\"element_styles_color\":\"\",\"element_styles_height\":\"\",\"element_styles_width\":\"\",\"element_styles_font-size\":\"\",\"element_styles_margin\":\"\",\"element_styles_padding\":\"\",\"element_styles_display\":\"\",\"element_styles_float\":\"\",\"element_styles_show_advanced_css\":\"0\",\"element_styles_advanced\":\"\",\"cellcid\":\"c3402\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"drawerDisabled\":false},\"id\":1},{\"settings\":{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":2,\"label\":\"\",\"key\":\"email\",\"type\":\"email\",\"created_at\":\"2019-12-30 21:26:55\",\"label_pos\":\"above\",\"required\":\"1\",\"placeholder\":\"Email *\",\"default\":\"\",\"wrapper_class\":\"\",\"element_class\":\"\",\"container_class\":\"one-half first\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"wrap_styles_background-color\":\"\",\"wrap_styles_border\":\"\",\"wrap_styles_border-style\":\"\",\"wrap_styles_border-color\":\"\",\"wrap_styles_color\":\"\",\"wrap_styles_height\":\"\",\"wrap_styles_width\":\"\",\"wrap_styles_font-size\":\"\",\"wrap_styles_margin\":\"\",\"wrap_styles_padding\":\"\",\"wrap_styles_display\":\"\",\"wrap_styles_float\":\"\",\"wrap_styles_show_advanced_css\":\"0\",\"wrap_styles_advanced\":\"\",\"label_styles_background-color\":\"\",\"label_styles_border\":\"\",\"label_styles_border-style\":\"\",\"label_styles_border-color\":\"\",\"label_styles_color\":\"\",\"label_styles_height\":\"\",\"label_styles_width\":\"\",\"label_styles_font-size\":\"\",\"label_styles_margin\":\"\",\"label_styles_padding\":\"\",\"label_styles_display\":\"\",\"label_styles_float\":\"\",\"label_styles_show_advanced_css\":\"0\",\"label_styles_advanced\":\"\",\"element_styles_background-color\":\"\",\"element_styles_border\":\"\",\"element_styles_border-style\":\"\",\"element_styles_border-color\":\"\",\"element_styles_color\":\"\",\"element_styles_height\":\"\",\"element_styles_width\":\"\",\"element_styles_font-size\":\"\",\"element_styles_margin\":\"\",\"element_styles_padding\":\"\",\"element_styles_display\":\"\",\"element_styles_float\":\"\",\"element_styles_show_advanced_css\":\"0\",\"element_styles_advanced\":\"\",\"cellcid\":\"c3406\",\"custom_name_attribute\":\"email\",\"personally_identifiable\":\"1\",\"value\":\"\",\"drawerDisabled\":false},\"id\":2},{\"settings\":{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":3,\"type\":\"phone\",\"label\":\"Phone\",\"key\":\"phone_1577743371768\",\"label_pos\":\"default\",\"required\":false,\"default\":\"\",\"placeholder\":\"Phone Number\",\"container_class\":\"one-half\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"admin_label\":\"\",\"help_text\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"custom_name_attribute\":\"phone\",\"personally_identifiable\":\"1\",\"value\":\"\",\"drawerDisabled\":false,\"wrap_styles_show_advanced_css\":0,\"label_styles_show_advanced_css\":0,\"element_styles_show_advanced_css\":0,\"cellcid\":\"c3409\"},\"id\":\"6\"},{\"settings\":{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":4,\"label\":\"Country\",\"type\":\"listcountry\",\"key\":\"listcountry_1577743391009\",\"label_pos\":\"default\",\"required\":1,\"options\":[{\"errors\":[],\"max_options\":0,\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"></i> Import</a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"></span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":0,\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"></i> Import</a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"></span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":0,\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"></i> Import</a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"></span>\",\"default\":0}}}}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"default\":\"US\",\"value\":\"US\",\"drawerDisabled\":false,\"wrap_styles_show_advanced_css\":0,\"label_styles_show_advanced_css\":0,\"element_styles_show_advanced_css\":0,\"list_item_row_styles_show_advanced_css\":0,\"list_item_label_styles_show_advanced_css\":0,\"list_item_element_styles_show_advanced_css\":0,\"cellcid\":\"c3412\"},\"id\":\"7\"},{\"settings\":{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":5,\"label\":\"\",\"type\":\"textarea\",\"key\":\"message_display\",\"label_pos\":\"default\",\"required\":1,\"default\":\"\",\"placeholder\":\"How can we help you?\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":true,\"admin_label\":\"\",\"help_text\":\"\",\"textarea_rte\":\"\",\"disable_rte_mobile\":\"\",\"textarea_media\":\"\",\"value\":\"\",\"drawerDisabled\":false,\"wrap_styles_show_advanced_css\":0,\"label_styles_show_advanced_css\":0,\"element_styles_show_advanced_css\":0,\"cellcid\":\"c3415\"},\"id\":\"251\"},{\"settings\":{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":6,\"label\":\"Select\",\"type\":\"listselect\",\"key\":\"listselect_1592008421709\",\"label_pos\":\"default\",\"required\":false,\"options\":[{\"errors\":[],\"max_options\":0,\"order\":0,\"new\":false,\"options\":[],\"label\":\"How did you hear about us?\",\"value\":\"How did you hear about us\",\"calc\":\"\",\"selected\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"></i> Import</a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"></span>\",\"default\":0}}},\"manual_value\":true},{\"errors\":[],\"max_options\":0,\"label\":\"Referral\",\"value\":\"Referral\",\"calc\":\"\",\"selected\":0,\"order\":1,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"></i> Import</a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"></span>\",\"default\":0}}},\"manual_value\":true},{\"errors\":[],\"max_options\":0,\"label\":\"Search Engine\",\"value\":\"Search Engine\",\"calc\":\"\",\"selected\":0,\"order\":2,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"></i> Import</a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"></span>\",\"default\":0}}},\"manual_value\":true},{\"errors\":[],\"max_options\":0,\"label\":\"Social Media\",\"value\":\"Social Media\",\"calc\":\"\",\"selected\":0,\"order\":3,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"></i> Import</a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"></span>\",\"default\":0}}},\"manual_value\":true},{\"errors\":[],\"max_options\":0,\"order\":4,\"new\":false,\"options\":[],\"label\":\"Word of Mouth\",\"value\":\"Word of Mouth\",\"calc\":\"\",\"selected\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"></i> Import</a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"></span>\",\"default\":0}}},\"manual_value\":true},{\"errors\":[],\"max_options\":0,\"order\":5,\"new\":false,\"options\":[],\"label\":\"Media (Newspaper, Magazine, TV, or Radio)\",\"value\":\"Media Newspaper Magazine TV or Radio\",\"calc\":\"\",\"selected\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"></i> Import</a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"></span>\",\"default\":0}}},\"manual_value\":true},{\"errors\":[],\"max_options\":0,\"order\":6,\"new\":false,\"options\":[],\"label\":\"Other\",\"value\":\"Other\",\"calc\":\"\",\"selected\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"></i> Import</a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"></span>\",\"default\":0}}},\"manual_value\":true}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"drawerDisabled\":false,\"wrap_styles_show_advanced_css\":0,\"label_styles_show_advanced_css\":0,\"element_styles_show_advanced_css\":0,\"cellcid\":\"c3418\"},\"id\":\"159\"},{\"settings\":{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":7,\"type\":\"hidden\",\"label\":\"Hidden\",\"key\":\"hidden_1609146455827\",\"default\":\"\",\"admin_label\":\"\",\"wrap_styles_border\":\"\",\"wrap_styles_width\":\"\",\"wrap_styles_margin\":\"\",\"wrap_styles_padding\":\"\",\"wrap_styles_float\":\"\",\"wrap_styles_show_advanced_css\":0,\"label_styles_border\":\"\",\"label_styles_width\":\"\",\"label_styles_font-size\":\"\",\"label_styles_margin\":\"\",\"label_styles_padding\":\"\",\"label_styles_float\":\"\",\"label_styles_show_advanced_css\":0,\"element_styles_border\":\"\",\"element_styles_width\":\"\",\"element_styles_font-size\":\"\",\"element_styles_margin\":\"\",\"element_styles_padding\":\"\",\"element_styles_float\":\"\",\"element_styles_show_advanced_css\":0,\"cellcid\":\"c3421\",\"drawerDisabled\":false},\"id\":\"398\"},{\"settings\":{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":8,\"type\":\"hidden\",\"label\":\"record type id\",\"key\":\"record_type_id_1609221866105\",\"default\":\"0123t000000miusAAA\",\"admin_label\":\"\",\"wrap_styles_border\":\"\",\"wrap_styles_width\":\"\",\"wrap_styles_margin\":\"\",\"wrap_styles_padding\":\"\",\"wrap_styles_float\":\"\",\"wrap_styles_show_advanced_css\":0,\"label_styles_border\":\"\",\"label_styles_width\":\"\",\"label_styles_font-size\":\"\",\"label_styles_margin\":\"\",\"label_styles_padding\":\"\",\"label_styles_float\":\"\",\"label_styles_show_advanced_css\":0,\"element_styles_border\":\"\",\"element_styles_width\":\"\",\"element_styles_font-size\":\"\",\"element_styles_margin\":\"\",\"element_styles_padding\":\"\",\"element_styles_float\":\"\",\"element_styles_show_advanced_css\":0,\"cellcid\":\"c3424\",\"drawerDisabled\":false},\"id\":\"401\"},{\"settings\":{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":9,\"type\":\"hidden\",\"label\":\"lead record type id\",\"key\":\"lead_record_type_id_1609221930394\",\"default\":\"0123t000000meiCAAQ\",\"admin_label\":\"\",\"wrap_styles_border\":\"\",\"wrap_styles_width\":\"\",\"wrap_styles_margin\":\"\",\"wrap_styles_padding\":\"\",\"wrap_styles_float\":\"\",\"wrap_styles_show_advanced_css\":0,\"label_styles_border\":\"\",\"label_styles_width\":\"\",\"label_styles_font-size\":\"\",\"label_styles_margin\":\"\",\"label_styles_padding\":\"\",\"label_styles_float\":\"\",\"label_styles_show_advanced_css\":0,\"element_styles_border\":\"\",\"element_styles_width\":\"\",\"element_styles_font-size\":\"\",\"element_styles_margin\":\"\",\"element_styles_padding\":\"\",\"element_styles_float\":\"\",\"element_styles_show_advanced_css\":0,\"cellcid\":\"c3427\",\"drawerDisabled\":false},\"id\":\"404\"},{\"settings\":{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":10,\"label\":\"Submit\",\"key\":\"submit\",\"type\":\"submit\",\"created_at\":\"2019-12-30 21:26:56\",\"processing_label\":\"Processing\",\"container_class\":\"\",\"element_class\":\"\",\"wrap_styles_background-color\":\"\",\"wrap_styles_border\":\"\",\"wrap_styles_border-style\":\"\",\"wrap_styles_border-color\":\"\",\"wrap_styles_color\":\"\",\"wrap_styles_height\":\"\",\"wrap_styles_width\":\"\",\"wrap_styles_font-size\":\"\",\"wrap_styles_margin\":\"\",\"wrap_styles_padding\":\"\",\"wrap_styles_display\":\"\",\"wrap_styles_float\":\"\",\"wrap_styles_show_advanced_css\":\"0\",\"wrap_styles_advanced\":\"\",\"label_styles_background-color\":\"\",\"label_styles_border\":\"\",\"label_styles_border-style\":\"\",\"label_styles_border-color\":\"\",\"label_styles_color\":\"\",\"label_styles_height\":\"\",\"label_styles_width\":\"\",\"label_styles_font-size\":\"\",\"label_styles_margin\":\"\",\"label_styles_padding\":\"\",\"label_styles_display\":\"\",\"label_styles_float\":\"\",\"label_styles_show_advanced_css\":\"0\",\"label_styles_advanced\":\"\",\"element_styles_background-color\":\"\",\"element_styles_border\":\"\",\"element_styles_border-style\":\"\",\"element_styles_border-color\":\"\",\"element_styles_color\":\"\",\"element_styles_height\":\"\",\"element_styles_width\":\"\",\"element_styles_font-size\":\"\",\"element_styles_margin\":\"\",\"element_styles_padding\":\"\",\"element_styles_display\":\"\",\"element_styles_float\":\"\",\"element_styles_show_advanced_css\":\"0\",\"element_styles_advanced\":\"\",\"submit_element_hover_styles_background-color\":\"\",\"submit_element_hover_styles_border\":\"\",\"submit_element_hover_styles_border-style\":\"\",\"submit_element_hover_styles_border-color\":\"\",\"submit_element_hover_styles_color\":\"\",\"submit_element_hover_styles_height\":\"\",\"submit_element_hover_styles_width\":\"\",\"submit_element_hover_styles_font-size\":\"\",\"submit_element_hover_styles_margin\":\"\",\"submit_element_hover_styles_padding\":\"\",\"submit_element_hover_styles_display\":\"\",\"submit_element_hover_styles_float\":\"\",\"submit_element_hover_styles_show_advanced_css\":\"0\",\"submit_element_hover_styles_advanced\":\"\",\"cellcid\":\"c3430\",\"drawerDisabled\":false},\"id\":4}],\"actions\":[{\"settings\":{\"objectType\":\"Action\",\"objectDomain\":\"actions\",\"editActive\":false,\"title\":\"\",\"key\":\"\",\"type\":\"save\",\"active\":\"1\",\"created_at\":\"2019-12-30 14:26:56\",\"label\":\"Store Submission\",\"conditions\":{\"collapsed\":\"\",\"process\":\"1\",\"connector\":\"all\",\"when\":[],\"then\":[{\"key\":\"\",\"trigger\":\"\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[]},\"payment_gateways\":\"\",\"payment_total\":\"0\",\"tag\":\"\",\"to\":\"{wp:admin_email}\",\"email_subject\":\"Ninja Forms Submission\",\"email_message\":\"{fields_table}\",\"from_name\":\"\",\"from_address\":\"\",\"reply_to\":\"\",\"email_format\":\"html\",\"cc\":\"\",\"bcc\":\"\",\"redirect_url\":\"\",\"email_message_plain\":\"\",\"message\":\"This action adds users to WordPress\' personal data export tool, allowing admins to comply with the GDPR and other privacy regulations from the site\'s front end.\",\"submitter_email\":\"\",\"fields-save-toggle\":\"save_all\",\"exception_fields\":[],\"set_subs_to_expire\":\"0\",\"subs_expire_time\":\"90\",\"success_msg\":\"Your form has been successfully submitted.\"},\"id\":1},{\"settings\":{\"objectType\":\"Action\",\"objectDomain\":\"actions\",\"editActive\":false,\"title\":\"\",\"key\":\"\",\"type\":\"email\",\"active\":\"1\",\"created_at\":\"2019-12-30 14:26:56\",\"label\":\"Email Confirmation\",\"to\":\"{field:email}\",\"subject\":\"This is an email action.\",\"message\":\"Hello, Ninja Forms!\",\"conditions\":{\"collapsed\":\"\",\"process\":\"1\",\"connector\":\"all\",\"when\":[],\"then\":[{\"key\":\"\",\"trigger\":\"\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[]},\"payment_gateways\":\"\",\"payment_total\":\"0\",\"tag\":\"\",\"email_subject\":\"Submission Confirmation \",\"email_message\":\"<p>Thank you for contacting us – we will get back to you soon.</p><p>{all_fields_table}<br></p>\",\"from_name\":\"\",\"from_address\":\"\",\"reply_to\":\"\",\"email_format\":\"html\",\"cc\":\"\",\"bcc\":\"\",\"email_message_plain\":\"\",\"drawerDisabled\":\"\"},\"id\":2},{\"settings\":{\"objectType\":\"Action\",\"objectDomain\":\"actions\",\"editActive\":false,\"title\":\"\",\"key\":\"\",\"type\":\"email\",\"active\":\"1\",\"created_at\":\"2019-12-30 14:26:56\",\"label\":\"Email Notification\",\"conditions\":{\"collapsed\":\"\",\"process\":\"1\",\"connector\":\"all\",\"when\":[],\"then\":[{\"key\":\"\",\"trigger\":\"\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[]},\"payment_gateways\":\"\",\"payment_total\":\"0\",\"tag\":\"\",\"to\":\" ben@anrclinicus.com,contact@anrclinicus.com\",\"email_subject\":\"New message from {field:name_1592252414561} - Contact Page\",\"email_message\":\"<p></p><p>{field:name_1592252414561}</p><p>{field:email}</p><p>{field:phone_1577743371768}</p><p>{field:listcountry_1577743391009}</p><p><br></p><p></p><p><br></p><p><br></p><p><br></p>\",\"from_name\":\"\",\"from_address\":\"\",\"reply_to\":\"{field:email}\",\"email_format\":\"html\",\"cc\":\"\",\"bcc\":\"\",\"attach_csv\":\"0\",\"email_message_plain\":\"\",\"message\":\"This action adds users to WordPress\' personal data delete tool, allowing admins to comply with the GDPR and other privacy regulations from the site\'s front end.\",\"drawerDisabled\":\"\"},\"id\":3},{\"settings\":{\"objectType\":\"Action\",\"objectDomain\":\"actions\",\"editActive\":false,\"title\":\"\",\"key\":\"\",\"type\":\"successmessage\",\"active\":\"0\",\"created_at\":\"2019-12-30 14:26:56\",\"label\":\"Success Message\",\"message\":\"Thank you {field:first_name_copy_1577743308439} for filling out my form!\",\"conditions\":{\"collapsed\":\"\",\"process\":\"1\",\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"\",\"comparator\":\"\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"\",\"trigger\":\"\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[]},\"payment_gateways\":\"\",\"payment_total\":\"0\",\"tag\":\"\",\"to\":\"{wp:admin_email}\",\"email_subject\":\"Ninja Forms Submission\",\"email_message\":\"{fields_table}\",\"from_name\":\"\",\"from_address\":\"\",\"reply_to\":\"\",\"email_format\":\"html\",\"cc\":\"\",\"bcc\":\"\",\"redirect_url\":\"\",\"success_msg\":\"<p>Form submitted successfully.</p><p>A confirmation email was sent to {field:email}.</p>\",\"email_message_plain\":\"\",\"submitter_email\":\"\",\"fields-save-toggle\":\"save_all\",\"exception_fields\":[],\"set_subs_to_expire\":\"0\",\"subs_expire_time\":\"90\"},\"id\":4},{\"settings\":{\"objectType\":\"Action\",\"objectDomain\":\"actions\",\"editActive\":false,\"type\":\"redirect\",\"active\":\"1\",\"created_at\":\"2020-01-14 10:40:36\",\"label\":\"Redirect\",\"conditions\":{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[{\"connector\":\"AND\",\"key\":\"\",\"comparator\":\"\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"when\"}],\"then\":[{\"key\":\"\",\"trigger\":\"\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[]},\"message\":\"This action adds users to WordPress\' personal data export tool, allowing admins to comply with the GDPR and other privacy regulations from the site\'s front end.\",\"payment_gateways\":\"\",\"payment_total\":\"0\",\"tag\":\"\",\"to\":\"{wp:admin_email}\",\"reply_to\":\"\",\"email_subject\":\"Ninja Forms Submission\",\"email_message\":\"{fields_table}\",\"email_message_plain\":\"\",\"from_name\":\"\",\"from_address\":\"\",\"email_format\":\"html\",\"cc\":\"\",\"bcc\":\"\",\"redirect_url\":\"https://anrclinic.nirazo.me/thank-you-2/\",\"drawerDisabled\":\"\",\"success_msg\":\"Your form has been successfully submitted.\"},\"id\":14},{\"settings\":{\"objectType\":\"Action\",\"objectDomain\":\"actions\",\"editActive\":false,\"type\":\"addtosalesforce\",\"active\":\"1\",\"created_at\":\"2020-12-28 09:36:19\",\"label\":\"Add To Salesforce\",\"drawerDisabled\":false,\"conditions\":{\"collapsed\":false,\"process\":1,\"connector\":\"all\",\"when\":[],\"then\":[{\"key\":\"\",\"trigger\":\"\",\"value\":\"\",\"type\":\"field\",\"modelType\":\"then\"}],\"else\":[]},\"to\":\"{wp:admin_email}\",\"reply_to\":\"\",\"email_subject\":\"Ninja Forms Submission\",\"email_message\":\"{fields_table}\",\"email_message_plain\":\"\",\"from_name\":\"\",\"from_address\":\"\",\"email_format\":\"html\",\"cc\":\"\",\"bcc\":\"\",\"success_msg\":\"Your form has been successfully submitted.\",\"redirect_url\":\"\",\"submitter_email\":\"\",\"fields-save-toggle\":\"save_all\",\"exception_fields\":[],\"set_subs_to_expire\":\"0\",\"subs_expire_time\":\"90\",\"tag\":\"\",\"payment_gateways\":\"\",\"payment_total\":\"0\",\"salesforce_field_map\":[{\"errors\":[],\"max_options\":0,\"order\":0,\"new\":false,\"options\":{\"form_field\":[],\"field_map\":[],\"special_instructions\":[]},\"form_field\":\"{field:name_1592252414561}\",\"field_map\":\"Form__c - Customer Name\",\"special_instructions\":\"\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"salesforce_field_map\",\"type\":\"option-repeater\",\"label\":\"Salesforce Field Map <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a>\",\"width\":\"full\",\"group\":\"primary\",\"tmpl_row\":\"nf-tmpl-salesforce-custom-field-map-row\",\"value\":[],\"columns\":{\"form_field\":{\"header\":\"Form Field\",\"default\":\"\",\"options\":[]},\"field_map\":{\"header\":\"Salesforce Field\",\"default\":\"\",\"options\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - LeadRecordtypeId\",\"value\":\"Form__c - LeadRecordtypeId\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - Emergency Email\",\"value\":\"Form__c - Emergency Email\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Emergency Phone\",\"value\":\"Form__c - Emergency Phone\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Financial Date\",\"value\":\"Form__c - Financial Date\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - First Name\",\"value\":\"Form__c - First Name\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Last Name\",\"value\":\"Form__c - Last Name\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Are you currently involve in research?\",\"value\":\"Form__c - Are you currently involve in research?\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - What is being studied?\",\"value\":\"Form__c - What is being studied?\"},{\"label\":\"Form__c - Contact Person with Clinic\",\"value\":\"Form__c - Contact Person with Clinic\"},{\"label\":\"Form__c - Patient Signature\",\"value\":\"Form__c - Patient Signature\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - Patient Name\",\"value\":\"Form__c - Patient Name\"},{\"label\":\"Form__c - Contact Information\",\"value\":\"Form__c - Contact Information\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Method of Disclosure\",\"value\":\"Form__c - Method of Disclosure\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Customer Name 1\",\"value\":\"Form__c - Customer Name 1\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - Relationship to Patient 1\",\"value\":\"Form__c - Relationship to Patient 1\"},{\"label\":\"Form__c - Contact Information 1\",\"value\":\"Form__c - Contact Information 1\"},{\"label\":\"Form__c - Method of Disclosure 1\",\"value\":\"Form__c - Method of Disclosure 1\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Customer Name 2\",\"value\":\"Form__c - Customer Name 2\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Relationship to Patient 2\",\"value\":\"Form__c - Relationship to Patient 2\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Contact Information 2\",\"value\":\"Form__c - Contact Information 2\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Method of Disclosure 3\",\"value\":\"Form__c - Method of Disclosure 3\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Customer Name 3\",\"value\":\"Form__c - Customer Name 3\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Relationship to Patient 3\",\"value\":\"Form__c - Relationship to Patient 3\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Contact Information 3\",\"value\":\"Form__c - Contact Information 3\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"},{\"label\":\"Form__c - Method of Disclosure 2\",\"value\":\"Form__c - Method of Disclosure 2\"},{\"label\":\"Form__c - Guardian’s Signature\",\"value\":\"Form__c - Guardian’s Signature\"},{\"label\":\"Form__c - Financial Policy Date\",\"value\":\"Form__c - Financial Policy Date\"},{\"label\":\"Form__c - Authorization Medical Date\",\"value\":\"Form__c - Authorization Medical Date\"},{\"label\":\"Form__c - Patient Date Of Birth\",\"value\":\"Form__c - Patient Date Of Birth\"},{\"label\":\"Form__c - Patient Signature Date\",\"value\":\"Form__c - Patient Signature Date\"},{\"label\":\"Form__c - When\",\"value\":\"Form__c - When\"},{\"label\":\"Form__c - Gurdian Signature Date\",\"value\":\"Form__c - Gurdian Signature Date\"}]},\"special_instructions\":{\"header\":\"Data Handling Instructions\",\"default\":\"\",\"options\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]}}}},{\"errors\":[],\"max_options\":0,\"order\":1,\"new\":false,\"options\":{\"form_field\":[],\"field_map\":[],\"special_instructions\":[]},\"form_field\":\"{field:email}\",\"field_map\":\"Form__c - Email\",\"special_instructions\":\"\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"salesforce_field_map\",\"type\":\"option-repeater\",\"label\":\"Salesforce Field Map <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a>\",\"width\":\"full\",\"group\":\"primary\",\"tmpl_row\":\"nf-tmpl-salesforce-custom-field-map-row\",\"value\":[],\"columns\":{\"form_field\":{\"header\":\"Form Field\",\"default\":\"\",\"options\":[]},\"field_map\":{\"header\":\"Salesforce Field\",\"default\":\"\",\"options\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - LeadRecordtypeId\",\"value\":\"Form__c - LeadRecordtypeId\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - Emergency Email\",\"value\":\"Form__c - Emergency Email\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Emergency Phone\",\"value\":\"Form__c - Emergency Phone\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Financial Date\",\"value\":\"Form__c - Financial Date\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - First Name\",\"value\":\"Form__c - First Name\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Last Name\",\"value\":\"Form__c - Last Name\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Are you currently involve in research?\",\"value\":\"Form__c - Are you currently involve in research?\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - What is being studied?\",\"value\":\"Form__c - What is being studied?\"},{\"label\":\"Form__c - Contact Person with Clinic\",\"value\":\"Form__c - Contact Person with Clinic\"},{\"label\":\"Form__c - Patient Signature\",\"value\":\"Form__c - Patient Signature\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - Patient Name\",\"value\":\"Form__c - Patient Name\"},{\"label\":\"Form__c - Contact Information\",\"value\":\"Form__c - Contact Information\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Method of Disclosure\",\"value\":\"Form__c - Method of Disclosure\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Customer Name 1\",\"value\":\"Form__c - Customer Name 1\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - Relationship to Patient 1\",\"value\":\"Form__c - Relationship to Patient 1\"},{\"label\":\"Form__c - Contact Information 1\",\"value\":\"Form__c - Contact Information 1\"},{\"label\":\"Form__c - Method of Disclosure 1\",\"value\":\"Form__c - Method of Disclosure 1\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Customer Name 2\",\"value\":\"Form__c - Customer Name 2\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Relationship to Patient 2\",\"value\":\"Form__c - Relationship to Patient 2\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Contact Information 2\",\"value\":\"Form__c - Contact Information 2\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Method of Disclosure 3\",\"value\":\"Form__c - Method of Disclosure 3\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Customer Name 3\",\"value\":\"Form__c - Customer Name 3\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Relationship to Patient 3\",\"value\":\"Form__c - Relationship to Patient 3\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Contact Information 3\",\"value\":\"Form__c - Contact Information 3\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"},{\"label\":\"Form__c - Method of Disclosure 2\",\"value\":\"Form__c - Method of Disclosure 2\"},{\"label\":\"Form__c - Guardian’s Signature\",\"value\":\"Form__c - Guardian’s Signature\"},{\"label\":\"Form__c - Financial Policy Date\",\"value\":\"Form__c - Financial Policy Date\"},{\"label\":\"Form__c - Authorization Medical Date\",\"value\":\"Form__c - Authorization Medical Date\"},{\"label\":\"Form__c - Patient Date Of Birth\",\"value\":\"Form__c - Patient Date Of Birth\"},{\"label\":\"Form__c - Patient Signature Date\",\"value\":\"Form__c - Patient Signature Date\"},{\"label\":\"Form__c - When\",\"value\":\"Form__c - When\"},{\"label\":\"Form__c - Gurdian Signature Date\",\"value\":\"Form__c - Gurdian Signature Date\"}]},\"special_instructions\":{\"header\":\"Data Handling Instructions\",\"default\":\"\",\"options\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]}}}},{\"errors\":[],\"max_options\":0,\"order\":2,\"new\":false,\"options\":{\"form_field\":[],\"field_map\":[],\"special_instructions\":[]},\"form_field\":\"{field:phone_1577743371768}\",\"field_map\":\"Form__c - Phone\",\"special_instructions\":\"\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"salesforce_field_map\",\"type\":\"option-repeater\",\"label\":\"Salesforce Field Map <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a>\",\"width\":\"full\",\"group\":\"primary\",\"tmpl_row\":\"nf-tmpl-salesforce-custom-field-map-row\",\"value\":[],\"columns\":{\"form_field\":{\"header\":\"Form Field\",\"default\":\"\",\"options\":[]},\"field_map\":{\"header\":\"Salesforce Field\",\"default\":\"\",\"options\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - LeadRecordtypeId\",\"value\":\"Form__c - LeadRecordtypeId\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - Emergency Email\",\"value\":\"Form__c - Emergency Email\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Emergency Phone\",\"value\":\"Form__c - Emergency Phone\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Financial Date\",\"value\":\"Form__c - Financial Date\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - First Name\",\"value\":\"Form__c - First Name\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Last Name\",\"value\":\"Form__c - Last Name\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Are you currently involve in research?\",\"value\":\"Form__c - Are you currently involve in research?\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - What is being studied?\",\"value\":\"Form__c - What is being studied?\"},{\"label\":\"Form__c - Contact Person with Clinic\",\"value\":\"Form__c - Contact Person with Clinic\"},{\"label\":\"Form__c - Patient Signature\",\"value\":\"Form__c - Patient Signature\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - Patient Name\",\"value\":\"Form__c - Patient Name\"},{\"label\":\"Form__c - Contact Information\",\"value\":\"Form__c - Contact Information\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Method of Disclosure\",\"value\":\"Form__c - Method of Disclosure\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Customer Name 1\",\"value\":\"Form__c - Customer Name 1\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"value\":\"Form__c - Location (approx.)\"},{\"label\":\"Form__c - Longitude\",\"value\":\"Form__c - Longitude\"},{\"label\":\"Form__c - Relationship to Patient 1\",\"value\":\"Form__c - Relationship to Patient 1\"},{\"label\":\"Form__c - Contact Information 1\",\"value\":\"Form__c - Contact Information 1\"},{\"label\":\"Form__c - Method of Disclosure 1\",\"value\":\"Form__c - Method of Disclosure 1\"},{\"label\":\"Form__c - MaritalStatus\",\"value\":\"Form__c - MaritalStatus\"},{\"label\":\"Form__c - Customer Name 2\",\"value\":\"Form__c - Customer Name 2\"},{\"label\":\"Form__c - Medication\",\"value\":\"Form__c - Medication\"},{\"label\":\"Form__c - Medium\",\"value\":\"Form__c - Medium\"},{\"label\":\"Form__c - Message\",\"value\":\"Form__c - Message\"},{\"label\":\"Form__c - Relationship to Patient 2\",\"value\":\"Form__c - Relationship to Patient 2\"},{\"label\":\"Form__c - Method of Use\",\"value\":\"Form__c - Method of Use\"},{\"label\":\"Form__c - Mobile\",\"value\":\"Form__c - Mobile\"},{\"label\":\"Form__c - Name\",\"value\":\"Form__c - Name\"},{\"label\":\"Form__c - No. of Employees\",\"value\":\"Form__c - No. of Employees\"},{\"label\":\"Form__c - Number of Website Visits\",\"value\":\"Form__c - Number of Website Visits\"},{\"label\":\"Form__c - Contact Information 2\",\"value\":\"Form__c - Contact Information 2\"},{\"label\":\"Form__c - Occupation\",\"value\":\"Form__c - Occupation\"},{\"label\":\"Form__c - Operating System\",\"value\":\"Form__c - Operating System\"},{\"label\":\"Form__c - Other Relevant Personal Remarks\",\"value\":\"Form__c - Other Relevant Personal Remarks\"},{\"label\":\"Form__c - Pages visited\",\"value\":\"Form__c - Pages visited\"},{\"label\":\"Form__c - ParagraphText\",\"value\":\"Form__c - ParagraphText\"},{\"label\":\"Form__c - Method of Disclosure 3\",\"value\":\"Form__c - Method of Disclosure 3\"},{\"label\":\"Form__c - Person Id\",\"value\":\"Form__c - Person Id\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - Phone\",\"value\":\"Form__c - Phone\"},{\"label\":\"Form__c - PleaseSelectOne\",\"value\":\"Form__c - PleaseSelectOne\"},{\"label\":\"Form__c - Please_Specify\",\"value\":\"Form__c - Please_Specify\"},{\"label\":\"Form__c - Please specify and describe reactions\",\"value\":\"Form__c - Please specify and describe reactions\"},{\"label\":\"Form__c - Pleasespecify19B\",\"value\":\"Form__c - Pleasespecify19B\"},{\"label\":\"Form__c - Pleasespecify21B\",\"value\":\"Form__c - Pleasespecify21B\"},{\"label\":\"Form__c - Pleasespecify7B\",\"value\":\"Form__c - Pleasespecify7B\"},{\"label\":\"Form__c - Preferred Language\",\"value\":\"Form__c - Preferred Language\"},{\"label\":\"Form__c - Preferred Pharmacy\",\"value\":\"Form__c - Preferred Pharmacy\"},{\"label\":\"Form__c - Customer Name 3\",\"value\":\"Form__c - Customer Name 3\"},{\"label\":\"Form__c - Primary Care Doctor\",\"value\":\"Form__c - Primary Care Doctor\"},{\"label\":\"Form__c - Primary Phone\",\"value\":\"Form__c - Primary Phone\"},{\"label\":\"Form__c - Relationship to Patient 3\",\"value\":\"Form__c - Relationship to Patient 3\"},{\"label\":\"Form__c - Race\",\"value\":\"Form__c - Race\"},{\"label\":\"Form__c - Rating\",\"value\":\"Form__c - Rating\"},{\"label\":\"Form__c - Referrer\",\"value\":\"Form__c - Referrer\"},{\"label\":\"Form__c - Referring URL\",\"value\":\"Form__c - Referring URL\"},{\"label\":\"Form__c - Relationship to Patient\",\"value\":\"Form__c - Relationship to Patient\"},{\"label\":\"Form__c - Route\",\"value\":\"Form__c - Route\"},{\"label\":\"Form__c - Select\",\"value\":\"Form__c - Select\"},{\"label\":\"Form__c - Contact Information 3\",\"value\":\"Form__c - Contact Information 3\"},{\"label\":\"Form__c - Social Security #\",\"value\":\"Form__c - Social Security #\"},{\"label\":\"Form__c - Some Number\",\"value\":\"Form__c - Some Number\"},{\"label\":\"Form__c - Source\",\"value\":\"Form__c - Source\"},{\"label\":\"Form__c - State\",\"value\":\"Form__c - State\"},{\"label\":\"Form__c - Street\",\"value\":\"Form__c - Street\"},{\"label\":\"Form__c - Submitted at\",\"value\":\"Form__c - Submitted at\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Spent on Website\",\"value\":\"Form__c - Time Spent on Website\"},{\"label\":\"Form__c - Time Zone\",\"value\":\"Form__c - Time Zone\"},{\"label\":\"Form__c - Title\",\"value\":\"Form__c - Title\"},{\"label\":\"Form__c - Website\",\"value\":\"Form__c - Website\"},{\"label\":\"Form__c - Weight\",\"value\":\"Form__c - Weight\"},{\"label\":\"Form__c - When Date\",\"value\":\"Form__c - When Date\"},{\"label\":\"Form__c - WhocantheCliniccontact\",\"value\":\"Form__c - WhocantheCliniccontact\"},{\"label\":\"Form__c - 10B Please specify\",\"value\":\"Form__c - 10B Please specify\"},{\"label\":\"Form__c - 11B Please specify\",\"value\":\"Form__c - 11B Please specify\"},{\"label\":\"Form__c - 12B Please specify\",\"value\":\"Form__c - 12B Please specify\"},{\"label\":\"Form__c - 13B Please specify\",\"value\":\"Form__c - 13B Please specify\"},{\"label\":\"Form__c - 14B Please specify\",\"value\":\"Form__c - 14B Please specify\"},{\"label\":\"Form__c - 15B Please specify\",\"value\":\"Form__c - 15B Please specify\"},{\"label\":\"Form__c - 16B Please specify\",\"value\":\"Form__c - 16B Please specify\"},{\"label\":\"Form__c - 17B Please specify\",\"value\":\"Form__c - 17B Please specify\"},{\"label\":\"Form__c - 18B Please specify\",\"value\":\"Form__c - 18B Please specify\"},{\"label\":\"Form__c - 19B Please specify\",\"value\":\"Form__c - 19B Please specify\"},{\"label\":\"Form__c - 1A\",\"value\":\"Form__c - 1A\"},{\"label\":\"Form__c - 1B\",\"value\":\"Form__c - 1B\"},{\"label\":\"Form__c - 21B Please specify\",\"value\":\"Form__c - 21B Please specify\"},{\"label\":\"Form__c - 2B If so, when?\",\"value\":\"Form__c - 2B If so, when?\"},{\"label\":\"Form__c - 3B Please specify and describe reactions\",\"value\":\"Form__c - 3B Please specify and describe reactions\"},{\"label\":\"Form__c - 5B Please specify\",\"value\":\"Form__c - 5B Please specify\"},{\"label\":\"Form__c - 7B Please specify\",\"value\":\"Form__c - 7B Please specify\"},{\"label\":\"Form__c - 8B Please specify\",\"value\":\"Form__c - 8B Please specify\"},{\"label\":\"Form__c - 9B Please specify\",\"value\":\"Form__c - 9B Please specify\"},{\"label\":\"Form__c - Zip\",\"value\":\"Form__c - Zip\"},{\"label\":\"Form__c - form_field_10\",\"value\":\"Form__c - form_field_10\"},{\"label\":\"Form__c - nf_field_102\",\"value\":\"Form__c - nf_field_102\"},{\"label\":\"Form__c - nf_field_105\",\"value\":\"Form__c - nf_field_105\"},{\"label\":\"Form__c - nf_field_108\",\"value\":\"Form__c - nf_field_108\"},{\"label\":\"Form__c - nf_field_111\",\"value\":\"Form__c - nf_field_111\"},{\"label\":\"Form__c - nf_field_114\",\"value\":\"Form__c - nf_field_114\"},{\"label\":\"Form__c - nf_field_117\",\"value\":\"Form__c - nf_field_117\"},{\"label\":\"Form__c - nf_field_120\",\"value\":\"Form__c - nf_field_120\"},{\"label\":\"Form__c - nf_field_123\",\"value\":\"Form__c - nf_field_123\"},{\"label\":\"Form__c - nf_field_126\",\"value\":\"Form__c - nf_field_126\"},{\"label\":\"Form__c - Sex\",\"value\":\"Form__c - Sex\"},{\"label\":\"Form__c - Marital Status\",\"value\":\"Form__c - Marital Status\"},{\"label\":\"Form__c - Craving scale while clean\",\"value\":\"Form__c - Craving scale while clean\"},{\"label\":\"Form__c - Methadone or Suboxone Maintenance?\",\"value\":\"Form__c - Methadone or Suboxone Maintenance?\"},{\"label\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\",\"value\":\"Form__c - Haveyoueverreceivedpsychiatrictreatment\"},{\"label\":\"Form__c - Prior suicide attempts?\",\"value\":\"Form__c - Prior suicide attempts?\"},{\"label\":\"Form__c - Allergies (Medications, Food, etc.)?\",\"value\":\"Form__c - Allergies (Medications, Food, etc.)?\"},{\"label\":\"Form__c - Past Surgeries\",\"value\":\"Form__c - Past Surgeries\"},{\"label\":\"Form__c - Hospitalization in the last two years?\",\"value\":\"Form__c - Hospitalization in the last two years?\"},{\"label\":\"Form__c - Adverse reactions to anesthesia\",\"value\":\"Form__c - Adverse reactions to anesthesia\"},{\"label\":\"Form__c - Emergency room visits in the last year?\",\"value\":\"Form__c - Emergency room visits in the last year?\"},{\"label\":\"Form__c - Accidents? (work, car etc)\",\"value\":\"Form__c - Accidents? (work, car etc)\"},{\"label\":\"Form__c - Head Injuries?\",\"value\":\"Form__c - Head Injuries?\"},{\"label\":\"Form__c - Loss of consciousness?\",\"value\":\"Form__c - Loss of consciousness?\"},{\"label\":\"Form__c - Loss of consciousness? Seizures?\",\"value\":\"Form__c - Loss of consciousness? Seizures?\"},{\"label\":\"Form__c - Heart disease?\",\"value\":\"Form__c - Heart disease?\"},{\"label\":\"Form__c - Lung disease?\",\"value\":\"Form__c - Lung disease?\"},{\"label\":\"Form__c - Liver disease / infections?\",\"value\":\"Form__c - Liver disease / infections?\"},{\"label\":\"Form__c - Kidney disease / problem?\",\"value\":\"Form__c - Kidney disease / problem?\"},{\"label\":\"Form__c - Diabetes?\",\"value\":\"Form__c - Diabetes?\"},{\"label\":\"Form__c - Ulcers?\",\"value\":\"Form__c - Ulcers?\"},{\"label\":\"Form__c - High Blood Pressure?\",\"value\":\"Form__c - High Blood Pressure?\"},{\"label\":\"Form__c - Asthma or shortness of breath?\\\"\",\"value\":\"Form__c - Asthma or shortness of breath?\\\"\"},{\"label\":\"Form__c - Obstructive sleep apnea?\",\"value\":\"Form__c - Obstructive sleep apnea?\"},{\"label\":\"Form__c - Pregnancy\",\"value\":\"Form__c - Pregnancy\"},{\"label\":\"Form__c - Month\",\"value\":\"Form__c - Month\"},{\"label\":\"Form__c - Day\",\"value\":\"Form__c - Day\"},{\"label\":\"Form__c - Year\",\"value\":\"Form__c - Year\"},{\"label\":\"Form__c - Method of Disclosure 2\",\"value\":\"Form__c - Method of Disclosure 2\"},{\"label\":\"Form__c - Guardian’s Signature\",\"value\":\"Form__c - Guardian’s Signature\"},{\"label\":\"Form__c - Financial Policy Date\",\"value\":\"Form__c - Financial Policy Date\"},{\"label\":\"Form__c - Authorization Medical Date\",\"value\":\"Form__c - Authorization Medical Date\"},{\"label\":\"Form__c - Patient Date Of Birth\",\"value\":\"Form__c - Patient Date Of Birth\"},{\"label\":\"Form__c - Patient Signature Date\",\"value\":\"Form__c - Patient Signature Date\"},{\"label\":\"Form__c - When\",\"value\":\"Form__c - When\"},{\"label\":\"Form__c - Gurdian Signature Date\",\"value\":\"Form__c - Gurdian Signature Date\"}]},\"special_instructions\":{\"header\":\"Data Handling Instructions\",\"default\":\"\",\"options\":[{\"label\":\"-None-\",\"value\":\"none\"},{\"label\":\"Check for duplicates in this field\",\"value\":\"DuplicateCheck\"},{\"label\":\"This is a date interval (ex: 2 days)\",\"value\":\"DateInterval\"},{\"label\":\"Format Date for Salesforce\",\"value\":\"DateFormat\"},{\"label\":\"File Upload\",\"value\":\"FileUpload\"},{\"label\":\"Format for true/false\",\"value\":\"ForceBoolean\"},{\"label\":\"Keep ampersands and quotes\",\"value\":\"KeepCharacters\"},{\"label\":\"Format for Currency\",\"value\":\"SalesforceCurrency\"},{\"label\":\"Separate selections with semi-colon\",\"value\":\"SemicolonDelimiter\"}]}}}},{\"errors\":[],\"max_options\":0,\"order\":3,\"new\":false,\"options\":{\"form_field\":[],\"field_map\":[],\"special_instructions\":[]},\"form_field\":\"{field:listcountry_1577743391009}\",\"field_map\":\"Form__c - Country\",\"special_instructions\":\"\",\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"salesforce_field_map\",\"type\":\"option-repeater\",\"label\":\"Salesforce Field Map <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New</a>\",\"width\":\"full\",\"group\":\"primary\",\"tmpl_row\":\"nf-tmpl-salesforce-custom-field-map-row\",\"value\":[],\"columns\":{\"form_field\":{\"header\":\"Form Field\",\"default\":\"\",\"options\":[]},\"field_map\":{\"header\":\"Salesforce Field\",\"default\":\"\",\"options\":[{\"label\":\"None\",\"value\":\"None\"},{\"label\":\"Form__c - Owner ID\",\"value\":\"Form__c - Owner ID\"},{\"label\":\"Form__c - Record Type ID\",\"value\":\"Form__c - Record Type ID\"},{\"label\":\"Form__c - LeadRecordtypeId\",\"value\":\"Form__c - LeadRecordtypeId\"},{\"label\":\"Form__c - Address\",\"value\":\"Form__c - Address\"},{\"label\":\"Form__c - Emergency Email\",\"value\":\"Form__c - Emergency Email\"},{\"label\":\"Form__c - All Traffic Sources\",\"value\":\"Form__c - All Traffic Sources\"},{\"label\":\"Form__c - Emergency Phone\",\"value\":\"Form__c - Emergency Phone\"},{\"label\":\"Form__c - Alternate Phone\",\"value\":\"Form__c - Alternate Phone\"},{\"label\":\"Form__c - Amount Per Day\",\"value\":\"Form__c - Amount Per Day\"},{\"label\":\"Form__c - Annual Revenue\",\"value\":\"Form__c - Annual Revenue\"},{\"label\":\"Form__c - Areyoucurrentlyaparticipant\",\"value\":\"Form__c - Areyoucurrentlyaparticipant\"},{\"label\":\"Form__c - Financial Date\",\"value\":\"Form__c - Financial Date\"},{\"label\":\"Form__c - Best time to Call\",\"value\":\"Form__c - Best time to Call\"},{\"label\":\"Form__c - Browser\",\"value\":\"Form__c - Browser\"},{\"label\":\"Form__c - Campaign\",\"value\":\"Form__c - Campaign\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - City\",\"value\":\"Form__c - City\"},{\"label\":\"Form__c - Company Id\",\"value\":\"Form__c - Company Id\"},{\"label\":\"Form__c - Company\",\"value\":\"Form__c - Company\"},{\"label\":\"Form__c - Contact Method\",\"value\":\"Form__c - Contact Method\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - Country\",\"value\":\"Form__c - Country\"},{\"label\":\"Form__c - First Name\",\"value\":\"Form__c - First Name\"},{\"label\":\"Form__c - Customer Name\",\"value\":\"Form__c - Customer Name\"},{\"label\":\"Form__c - Customer Phone Number\",\"value\":\"Form__c - Customer Phone Number\"},{\"label\":\"Form__c - Data.com Key\",\"value\":\"Form__c - Data.com Key\"},{\"label\":\"Form__c - DateDt\",\"value\":\"Form__c - DateDt\"},{\"label\":\"Form__c - Date Of Birth\",\"value\":\"Form__c - Date Of Birth\"},{\"label\":\"Form__c - Date\",\"value\":\"Form__c - Date\"},{\"label\":\"Form__c - Date of Enrolment\",\"value\":\"Form__c - Date of Enrolment\"},{\"label\":\"Form__c - Datetime of Enrollment\",\"value\":\"Form__c - Datetime of Enrollment\"},{\"label\":\"Form__c - Delete From Salesforce\",\"value\":\"Form__c - Delete From Salesforce\"},{\"label\":\"Form__c - Description\",\"value\":\"Form__c - Description\"},{\"label\":\"Form__c - Device\",\"value\":\"Form__c - Device\"},{\"label\":\"Form__c - Last Name\",\"value\":\"Form__c - Last Name\"},{\"label\":\"Form__c - Do Not Call\",\"value\":\"Form__c - Do Not Call\"},{\"label\":\"Form__c - Dose\",\"value\":\"Form__c - Dose\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Drug Name\",\"value\":\"Form__c - Drug Name\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Email Opt Out\",\"value\":\"Form__c - Email Opt Out\"},{\"label\":\"Form__c - Email\",\"value\":\"Form__c - Email\"},{\"label\":\"Form__c - Are you currently involve in research?\",\"value\":\"Form__c - Are you currently involve in research?\"},{\"label\":\"Form__c - Ethnicity\",\"value\":\"Form__c - Ethnicity\"},{\"label\":\"Form__c - Fax Opt Out\",\"value\":\"Form__c - Fax Opt Out\"},{\"label\":\"Form__c - Fax\",\"value\":\"Form__c - Fax\"},{\"label\":\"Form__c - First Click Campaign\",\"value\":\"Form__c - First Click Campaign\"},{\"label\":\"Form__c - First Click Channel\",\"value\":\"Form__c - First Click Channel\"},{\"label\":\"Form__c - First Click Content\",\"value\":\"Form__c - First Click Content\"},{\"label\":\"Form__c - First Click Landing Page\",\"value\":\"Form__c - First Click Landing Page\"},{\"label\":\"Form__c - First Click Medium\",\"value\":\"Form__c - First Click Medium\"},{\"label\":\"Form__c - First Click Referrer\",\"value\":\"Form__c - First Click Referrer\"},{\"label\":\"Form__c - First Click Source\",\"value\":\"Form__c - First Click Source\"},{\"label\":\"Form__c - First Click Term\",\"value\":\"Form__c - First Click Term\"},{\"label\":\"Form__c - First Form\",\"value\":\"Form__c - First Form\"},{\"label\":\"Form__c - First and Last Name Emergency\",\"value\":\"Form__c - First and Last Name Emergency\"},{\"label\":\"Form__c - Follow Up?\",\"value\":\"Form__c - Follow Up?\"},{\"label\":\"Form__c - For_How_Long\",\"value\":\"Form__c - For_How_Long\"},{\"label\":\"Form__c - For How Long?\",\"value\":\"Form__c - For How Long?\"},{\"label\":\"Form__c - Form Url\",\"value\":\"Form__c - Form Url\"},{\"label\":\"Form__c - Formatted Customer Name\",\"value\":\"Form__c - Formatted Customer Name\"},{\"label\":\"Form__c - Formatted Customer Phone Number\",\"value\":\"Form__c - Formatted Customer Phone Number\"},{\"label\":\"Form__c - Frequency\",\"value\":\"Form__c - Frequency\"},{\"label\":\"Form__c - GA Client ID (Formula)\",\"value\":\"Form__c - GA Client ID (Formula)\"},{\"label\":\"Form__c - GCLID Google Ads\",\"value\":\"Form__c - GCLID Google Ads\"},{\"label\":\"Form__c - GCLID\",\"value\":\"Form__c - GCLID\"},{\"label\":\"Form__c - General remarks\",\"value\":\"Form__c - General remarks\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Client ID\",\"value\":\"Form__c - Google Analytics Client ID\"},{\"label\":\"Form__c - Google Analytics Link\",\"value\":\"Form__c - Google Analytics Link\"},{\"label\":\"Form__c - Google Analytics Tracking ID\",\"value\":\"Form__c - Google Analytics Tracking ID\"},{\"label\":\"Form__c - What is being studied?\",\"value\":\"Form__c - What is being studied?\"},{\"label\":\"Form__c - Contact Person with Clinic\",\"value\":\"Form__c - Contact Person with Clinic\"},{\"label\":\"Form__c - Patient Signature\",\"value\":\"Form__c - Patient Signature\"},{\"label\":\"Form__c - Height\",\"value\":\"Form__c - Height\"},{\"label\":\"Form__c - Patient Name\",\"value\":\"Form__c - Patient Name\"},{\"label\":\"Form__c - Contact Information\",\"value\":\"Form__c - Contact Information\"},{\"label\":\"Form__c - How can we help you?\",\"value\":\"Form__c - How can we help you?\"},{\"label\":\"Form__c - IP Address\",\"value\":\"Form__c - IP Address\"},{\"label\":\"Form__c - Id\",\"value\":\"Form__c - Id\"},{\"label\":\"Form__c - Ifsowhen2B\",\"value\":\"Form__c - Ifsowhen2B\"},{\"label\":\"Form__c - Ifyespleasebriefly\",\"value\":\"Form__c - Ifyespleasebriefly\"},{\"label\":\"Form__c - Industry\",\"value\":\"Form__c - Industry\"},{\"label\":\"Form__c - Institution or Clinic\",\"value\":\"Form__c - Institution or Clinic\"},{\"label\":\"Form__c - Keywords\",\"value\":\"Form__c - Keywords\"},{\"label\":\"Form__c - Method of Disclosure\",\"value\":\"Form__c - Method of Disclosure\"},{\"label\":\"Form__c - Landing Page URL\",\"value\":\"Form__c - Landing Page URL\"},{\"label\":\"Form__c - Last Click Campaign\",\"value\":\"Form__c - Last Click Campaign\"},{\"label\":\"Form__c - Last Click Channel\",\"value\":\"Form__c - Last Click Channel\"},{\"label\":\"Form__c - Last Click Content\",\"value\":\"Form__c - Last Click Content\"},{\"label\":\"Form__c - Last Click Landing Page\",\"value\":\"Form__c - Last Click Landing Page\"},{\"label\":\"Form__c - Last Click Medium\",\"value\":\"Form__c - Last Click Medium\"},{\"label\":\"Form__c - Last Click Referrer\",\"value\":\"Form__c - Last Click Referrer\"},{\"label\":\"Form__c - Last Click Source/Medium\",\"value\":\"Form__c - Last Click Source/Medium\"},{\"label\":\"Form__c - Last Click Source\",\"value\":\"Form__c - Last Click Source\"},{\"label\":\"Form__c - Last Click Term\",\"value\":\"Form__c - Last Click Term\"},{\"label\":\"Form__c - Last Transfer Date\",\"value\":\"Form__c - Last Transfer Date\"},{\"label\":\"Form__c - Latitude\",\"value\":\"Form__c - Latitude\"},{\"label\":\"Form__c - Customer Name 1\",\"value\":\"Form__c - Customer Name 1\"},{\"label\":\"Form__c - Location\",\"value\":\"Form__c - Location\"},{\"label\":\"Form__c - Location (approx.)\",\"