{"id":1732,"date":"2021-11-03T16:29:35","date_gmt":"2021-11-03T16:29:35","guid":{"rendered":"http:\/\/www.truthforhealth.org\/?page_id=1732"},"modified":"2022-08-08T00:05:07","modified_gmt":"2022-08-08T00:05:07","slug":"covid-care-strategy-team-2","status":"publish","type":"page","link":"https:\/\/www.truthforhealth.org\/es\/covid-care-strategy-team-2\/","title":{"rendered":"COVID CARE STRATEGY TEAM"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">The COVID Care Strategy Team rescues patients and families from hospitals. If you or someone you know is being involuntarily held and are risking loss of life by deadly hospital COVID protocols TAKE ACTION NOW. We can help! <\/p>\n\n\n\n<p class=\"has-medium-font-size wp-block-paragraph\">STEP 1 &#8211; Complete Clinical Intake Form Below <\/p>\n\n\n\n<h2 class=\"wp-block-heading\"> COVID CARE STRATEGY TEAM: Clinical Intake Form<\/h2>\n\n\n<div class=\"wpforms-container wpforms-container-full wpforms-container-save-resume\" id=\"wpforms-2716\"><form id=\"wpforms-form-2716\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"2716\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/es\/wp-json\/wp\/v2\/pages\/1732\" data-token=\"0096571e4974e70ad7e4ce5c3144cbe4\" data-token-time=\"1792779471\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-2716-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"1\"><label class=\"wpforms-field-label\">Patient Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-2716-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" required><label for=\"wpforms-2716-field_1\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2716-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" required><label for=\"wpforms-2716-field_1-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-2716-field_3-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_3\">Age<\/label><input type=\"number\" id=\"wpforms-2716-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" step=\"any\" ><\/div><div id=\"wpforms-2716-field_6-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_6\">DOB<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2716-field_6\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][6][date]\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-2716-field_7-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"7\"><label class=\"wpforms-field-label\">Sex<\/label><ul id=\"wpforms-2716-field_7\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_7_1\" name=\"wpforms[fields][7]\" value=\"Male\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_7_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_7_2\" name=\"wpforms[fields][7]\" value=\"Female\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_7_2\">Female<\/label><\/li><\/ul><\/div><div id=\"wpforms-2716-field_8-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"8\"><label class=\"wpforms-field-label\">Patient&#039;s POA Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-2716-field_8\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][8][first]\" required><label for=\"wpforms-2716-field_8\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2716-field_8-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][8][last]\" required><label for=\"wpforms-2716-field_8-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-2716-field_14-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_14\">POA&#039;s Phone Number<\/label><input type=\"tel\" id=\"wpforms-2716-field_14\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][14]\" aria-label=\"POA&#039;s Phone Number\" ><\/div><div id=\"wpforms-2716-field_15-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_15\">Family Contact Phone Number<\/label><input type=\"tel\" id=\"wpforms-2716-field_15\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][15]\" aria-label=\"Family Contact Phone Number\" ><\/div><div id=\"wpforms-2716-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_11\">Patient&#039;s Location (State &amp; Hospital)<\/label><input type=\"text\" id=\"wpforms-2716-field_11\" class=\"wpforms-field-medium\" name=\"wpforms[fields][11]\" ><\/div><div id=\"wpforms-2716-field_13-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_13\">Hospital&#039;s Phone Number<\/label><input type=\"tel\" id=\"wpforms-2716-field_13\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][13]\" aria-label=\"Hospital&#039;s Phone Number\" ><\/div><div id=\"wpforms-2716-field_16-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_16\">Level of Care<\/label><textarea id=\"wpforms-2716-field_16\" class=\"wpforms-field-medium\" name=\"wpforms[fields][16]\" ><\/textarea><\/div><div id=\"wpforms-2716-field_17-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"17\"><label class=\"wpforms-field-label\">Is patient on ventilator? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2716-field_17\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_17_1\" name=\"wpforms[fields][17]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_17_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_17_2\" name=\"wpforms[fields][17]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_17_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2716-field_18-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_18\">If ventilated, how long (days)?<\/label><input type=\"number\" id=\"wpforms-2716-field_18\" class=\"wpforms-field-medium\" name=\"wpforms[fields][18]\" step=\"any\" ><\/div><div id=\"wpforms-2716-field_19-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_19\">Date Patient Admitted<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2716-field_19\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][19][date]\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-2716-field_20-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"20\"><label class=\"wpforms-field-label\">Date of COVID-19 Diagnosis<\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-date-type-datepicker\"><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2716-field_20\" class=\"wpforms-field-date-time-date wpforms-datepicker\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][20][date]\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><label for=\"wpforms-2716-field_20\" class=\"wpforms-field-sublabel after\">Date<\/label><\/div><div class=\"wpforms-field-row-block\"><input type=\"text\" id=\"wpforms-2716-field_20-time\" class=\"wpforms-field-date-time-time wpforms-timepicker\" data-time-format=\"g:i A\" data-step=\"30\" data-rule-time12h=\"true\" name=\"wpforms[fields][20][time]\" ><label for=\"wpforms-2716-field_20-time\" class=\"wpforms-field-sublabel after\">Time<\/label><\/div><\/div><\/div><div id=\"wpforms-2716-field_21-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"21\"><label class=\"wpforms-field-label\">Did Patient Receive Any Early Treatment Interventions Before Admission?<\/label><ul id=\"wpforms-2716-field_21\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_21_1\" name=\"wpforms[fields][21]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_21_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_21_2\" name=\"wpforms[fields][21]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_21_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2716-field_22-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_22\">What Treatment Was Given?<\/label><textarea id=\"wpforms-2716-field_22\" class=\"wpforms-field-medium\" name=\"wpforms[fields][22]\" ><\/textarea><\/div><div id=\"wpforms-2716-field_23-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"23\"><label class=\"wpforms-field-label\">Name of Attending Physician <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-2716-field_23\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][23][first]\" required><label for=\"wpforms-2716-field_23\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2716-field_23-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][23][last]\" required><label for=\"wpforms-2716-field_23-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-2716-field_24-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_24\">Attending Physician&#039;s Phone<\/label><input type=\"tel\" id=\"wpforms-2716-field_24\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][24]\" aria-label=\"Attending Physician&#039;s Phone\" ><\/div><div id=\"wpforms-2716-field_25-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_25\">Describe Patient&#039;s Current Condition<\/label><textarea id=\"wpforms-2716-field_25\" class=\"wpforms-field-medium\" name=\"wpforms[fields][25]\" ><\/textarea><\/div><div id=\"wpforms-2716-field_26-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"26\"><label class=\"wpforms-field-label\">Patient On Oxygen?<\/label><ul id=\"wpforms-2716-field_26\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_26_1\" name=\"wpforms[fields][26]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_26_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_26_2\" name=\"wpforms[fields][26]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_26_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2716-field_27-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_27\">Flow Rate (L\/min)<\/label><input type=\"number\" id=\"wpforms-2716-field_27\" class=\"wpforms-field-medium\" name=\"wpforms[fields][27]\" step=\"any\" ><\/div><div id=\"wpforms-2716-field_28-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_28\">Type of Oxygen Delivery<\/label><input type=\"text\" id=\"wpforms-2716-field_28\" class=\"wpforms-field-medium\" name=\"wpforms[fields][28]\" ><\/div><div id=\"wpforms-2716-field_29-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_29\">Any Other Respiratory Equipment In Use (CPAP, BiPap, AutoPap, Other)?<\/label><input type=\"text\" id=\"wpforms-2716-field_29\" class=\"wpforms-field-medium\" name=\"wpforms[fields][29]\" ><\/div><div id=\"wpforms-2716-field_30-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"30\"><label class=\"wpforms-field-label\">Has Remdesivir Been Given?<\/label><ul id=\"wpforms-2716-field_30\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_30_1\" name=\"wpforms[fields][30]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_30_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_30_2\" name=\"wpforms[fields][30]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_30_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2716-field_31-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_31\">Number of Days of Treatment<\/label><input type=\"number\" id=\"wpforms-2716-field_31\" class=\"wpforms-field-medium\" name=\"wpforms[fields][31]\" step=\"any\" ><\/div><div id=\"wpforms-2716-field_32-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"32\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_32\">Patient&#039;s Current Medications\/Doses<\/label><textarea id=\"wpforms-2716-field_32\" class=\"wpforms-field-medium\" name=\"wpforms[fields][32]\" ><\/textarea><\/div><div id=\"wpforms-2716-field_33-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"33\"><label class=\"wpforms-field-label\">Is Patient on Any Type of Nutrition?<\/label><ul id=\"wpforms-2716-field_33\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_33_1\" name=\"wpforms[fields][33]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_33_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_33_2\" name=\"wpforms[fields][33]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_33_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2716-field_34-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_34\">Nutrition Type<\/label><input type=\"text\" id=\"wpforms-2716-field_34\" class=\"wpforms-field-medium\" name=\"wpforms[fields][34]\" ><\/div><div id=\"wpforms-2716-field_35-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"35\"><label class=\"wpforms-field-label\">Is Patient Receiving IV Fluids?<\/label><ul id=\"wpforms-2716-field_35\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_35_1\" name=\"wpforms[fields][35]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_35_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_35_2\" name=\"wpforms[fields][35]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_35_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2716-field_36-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_36\">Type (If Known)<\/label><input type=\"text\" id=\"wpforms-2716-field_36\" class=\"wpforms-field-medium\" name=\"wpforms[fields][36]\" ><\/div><div id=\"wpforms-2716-field_37-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"37\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_37\">Date of Last Contact With Patient<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2716-field_37\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][37][date]\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-2716-field_38-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"38\"><label class=\"wpforms-field-label\">Contact Type<\/label><ul id=\"wpforms-2716-field_38\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_38_1\" name=\"wpforms[fields][38]\" value=\"In Person\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_38_1\">In Person<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_38_2\" name=\"wpforms[fields][38]\" value=\"By Phone\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_38_2\">By Phone<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_38_3\" name=\"wpforms[fields][38]\" value=\"Video\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_38_3\">Video<\/label><\/li><\/ul><\/div><div id=\"wpforms-2716-field_39-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"39\"><label class=\"wpforms-field-label\">Faith Background<\/label><ul id=\"wpforms-2716-field_39\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_39_1\" name=\"wpforms[fields][39]\" value=\"Catholic\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_39_1\">Catholic<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_39_2\" name=\"wpforms[fields][39]\" value=\"Protestant\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_39_2\">Protestant<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_39_3\" name=\"wpforms[fields][39]\" value=\"Jewish\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_39_3\">Jewish<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_39_4\" name=\"wpforms[fields][39]\" value=\"Muslim\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_39_4\">Muslim<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_39_5\" name=\"wpforms[fields][39]\" value=\"Hindu\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_39_5\">Hindu<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_39_6\" name=\"wpforms[fields][39]\" value=\"Other\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_39_6\">Other<\/label><\/li><\/ul><\/div><div id=\"wpforms-2716-field_40-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"40\"><h3 id=\"wpforms-2716-field_40\">DOES PATIENT HAVE ANY OF THESE MEDICAL CONDITIONS?<\/h3><\/div><div id=\"wpforms-2716-field_42-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"42\"><label class=\"wpforms-field-label\">Obesity,  Heart Disease, History of Heart Attack, Arrhythmias, High Blood Pressure, TIA, or Stroke?<\/label><ul id=\"wpforms-2716-field_42\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_42_1\" name=\"wpforms[fields][42]\" value=\"YES\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_42_1\">YES<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_42_2\" name=\"wpforms[fields][42]\" value=\"NO\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_42_2\">NO<\/label><\/li><\/ul><\/div><div id=\"wpforms-2716-field_43-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"43\"><label class=\"wpforms-field-label\">Lung Disease (COPD, Asthma, Pulmonary Fibrosis, Other)?<\/label><ul id=\"wpforms-2716-field_43\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_43_1\" name=\"wpforms[fields][43]\" value=\"YES\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_43_1\">YES<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_43_2\" name=\"wpforms[fields][43]\" value=\"NO\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_43_2\">NO<\/label><\/li><\/ul><\/div><div id=\"wpforms-2716-field_44-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"44\"><label class=\"wpforms-field-label\">Kidney Disease?<\/label><ul id=\"wpforms-2716-field_44\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_44_1\" name=\"wpforms[fields][44]\" value=\"YES\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_44_1\">YES<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_44_2\" name=\"wpforms[fields][44]\" value=\"NO\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_44_2\">NO<\/label><\/li><\/ul><\/div><div id=\"wpforms-2716-field_48-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"48\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_48\">Kidney Disease Type<\/label><input type=\"text\" id=\"wpforms-2716-field_48\" class=\"wpforms-field-medium\" name=\"wpforms[fields][48]\" ><\/div><div id=\"wpforms-2716-field_45-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"45\"><label class=\"wpforms-field-label\">Diabetes, Metabolic Syndrome\/Insulin Resistance?<\/label><ul id=\"wpforms-2716-field_45\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_45_1\" name=\"wpforms[fields][45]\" value=\"YES\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_45_1\">YES<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_45_2\" name=\"wpforms[fields][45]\" value=\"NO\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_45_2\">NO<\/label><\/li><\/ul><\/div><div id=\"wpforms-2716-field_46-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"46\"><label class=\"wpforms-field-label\">Taking Insulin?<\/label><ul id=\"wpforms-2716-field_46\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_46_1\" name=\"wpforms[fields][46]\" value=\"YES\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_46_1\">YES<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_46_2\" name=\"wpforms[fields][46]\" value=\"NO\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_46_2\">NO<\/label><\/li><\/ul><\/div><div id=\"wpforms-2716-field_47-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"47\"><label class=\"wpforms-field-label\">Any Kind of Cancer?<\/label><ul id=\"wpforms-2716-field_47\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_47_1\" name=\"wpforms[fields][47]\" value=\"YES\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_47_1\">YES<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_47_2\" name=\"wpforms[fields][47]\" value=\"NO\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_47_2\">NO<\/label><\/li><\/ul><\/div><div id=\"wpforms-2716-field_49-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_49\">Cancer Type, Treatment Type, Current\/Past?<\/label><input type=\"text\" id=\"wpforms-2716-field_49\" class=\"wpforms-field-medium\" name=\"wpforms[fields][49]\" ><\/div><div id=\"wpforms-2716-field_50-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"50\"><label class=\"wpforms-field-label\">Any Type of Autoimmune Disease?<\/label><ul id=\"wpforms-2716-field_50\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_50_1\" name=\"wpforms[fields][50]\" value=\"YES\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_50_1\">YES<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_50_2\" name=\"wpforms[fields][50]\" value=\"NO\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_50_2\">NO<\/label><\/li><\/ul><\/div><div id=\"wpforms-2716-field_51-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"51\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_51\">Autoimmune Disease Type (Thyroid, Lupus, Rheumatoid Arthritis, Multiple Sclerosis, Other)?<\/label><input type=\"text\" id=\"wpforms-2716-field_51\" class=\"wpforms-field-medium\" name=\"wpforms[fields][51]\" ><\/div><div id=\"wpforms-2716-field_52-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"52\"><label class=\"wpforms-field-label\">Has Patient Been Taking Corticosteroid Medicines Daily for Any Condition?<\/label><ul id=\"wpforms-2716-field_52\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_52_1\" name=\"wpforms[fields][52]\" value=\"YES\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_52_1\">YES<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_52_2\" name=\"wpforms[fields][52]\" value=\"NO\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_52_2\">NO<\/label><\/li><\/ul><\/div><div id=\"wpforms-2716-field_53-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"53\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_53\">Type of Corticosteroid Medicine and Dose<\/label><input type=\"text\" id=\"wpforms-2716-field_53\" class=\"wpforms-field-medium\" name=\"wpforms[fields][53]\" ><\/div><div id=\"wpforms-2716-field_54-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_54\">For Family and POA: What is your immediate goal for the patient&#039;s medical care?<\/label><textarea id=\"wpforms-2716-field_54\" class=\"wpforms-field-medium\" name=\"wpforms[fields][54]\" ><\/textarea><\/div><div id=\"wpforms-2716-field_55-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"55\"><label class=\"wpforms-field-label\" for=\"wpforms-2716-field_55\">What is the patient&#039;s support network for home-based care? Family members in home? Who?<\/label><textarea id=\"wpforms-2716-field_55\" class=\"wpforms-field-medium\" name=\"wpforms[fields][55]\" ><\/textarea><\/div><div id=\"wpforms-2716-field_56-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"56\"><label class=\"wpforms-field-label\">Family Available to Be With Patient?<\/label><ul id=\"wpforms-2716-field_56\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_56_1\" name=\"wpforms[fields][56]\" value=\"YES\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_56_1\">YES<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_56_2\" name=\"wpforms[fields][56]\" value=\"NO\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_56_2\">NO<\/label><\/li><\/ul><\/div><div id=\"wpforms-2716-field_57-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"57\"><label class=\"wpforms-field-label\">Friends\/Neighbors Available to Help?<\/label><ul id=\"wpforms-2716-field_57\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_57_1\" name=\"wpforms[fields][57]\" value=\"YES\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_57_1\">YES<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_57_2\" name=\"wpforms[fields][57]\" value=\"NO\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_57_2\">NO<\/label><\/li><\/ul><\/div><div id=\"wpforms-2716-field_58-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"58\"><label class=\"wpforms-field-label\">Faith Community Support?<\/label><ul id=\"wpforms-2716-field_58\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_58_1\" name=\"wpforms[fields][58]\" value=\"YES\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_58_1\">YES<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_58_2\" name=\"wpforms[fields][58]\" value=\"NO\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_58_2\">NO<\/label><\/li><\/ul><\/div><div id=\"wpforms-2716-field_59-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"59\"><label class=\"wpforms-field-label\">Type of Medical Insurance<\/label><ul id=\"wpforms-2716-field_59\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_59_1\" name=\"wpforms[fields][59]\" value=\"Medicare\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_59_1\">Medicare<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_59_2\" name=\"wpforms[fields][59]\" value=\"Medicaid\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_59_2\">Medicaid<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_59_3\" name=\"wpforms[fields][59]\" value=\"Commercial\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_59_3\">Commercial<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-2716-field_59_4\" name=\"wpforms[fields][59]\" value=\"Govt (TriCare, VA, IHS, Federal Employee)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2716-field_59_4\">Govt (TriCare, VA, IHS, Federal Employee)<\/label><\/li><\/ul><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"2716\"><input type=\"hidden\" name=\"wpforms[time_token]\" value=\"1792779471.ec69d5daa9c6500719caf032590385866856a6d907b44beee3954dae686ae2a8\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/www.truthforhealth.org\/es\/wp-json\/wp\/v2\/pages\/1732\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-2716\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.truthforhealth.org\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"has-medium-font-size wp-block-paragraph\"> STEP 2 &#8211; Complete the Patient Confidentiality Form<\/p>\n\n\n<div class=\"wpforms-container wpforms-container-full wpforms-container-save-resume\" id=\"wpforms-3288\"><form id=\"wpforms-form-3288\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"3288\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/es\/wp-json\/wp\/v2\/pages\/1732\" data-token=\"536e9ed0771fa16e5be3d216a99e0992\" data-token-time=\"1792779471\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-3288-field_2-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"2\"><label class=\"wpforms-field-label\">Patient Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-3288-field_2\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][2][first]\" required><label for=\"wpforms-3288-field_2\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-3288-field_2-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][2][last]\" required><label for=\"wpforms-3288-field_2-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-3288-field_4-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-3288-field_4\">Patient Date of Birth <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-3288-field_4\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][4][date]\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-3288-field_5-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-3288-field_5\">Patient Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-3288-field_5\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][5]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-3288-field_1-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"1\"><div id=\"wpforms-3288-field_1\"><p>Truth for Health Foundation is a 501(c)(3) public charity incorporated in AZ, USA and approved as a non-profit under IRS regulations. In consideration of my entering into a role with Truth for Health Foundation (hereinafter, \u201cThe Foundation\u201d), as the patient for myself requesting referral and resource assistance from The Foundation medical and nursing advisors and affiliated independent medical services professionals, I agree as follows: <\/p><\/div><\/div><div id=\"wpforms-3288-field_6-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"6\"><div id=\"wpforms-3288-field_6\"><p><strong>A. CONFIDENTIALITY<\/strong><\/p><\/div><\/div><div id=\"wpforms-3288-field_7-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"7\"><div id=\"wpforms-3288-field_7\"><p>I realize that my discussions and\/or consulting\/ role with The Foundation creates a relationship of high trust and confidence with respect to Confidential Personal and Protected Medical Information I may provide to the Foundation on behalf of my treatment and Confidential Information owned by or in the possession of The Foundation that may be learned or developed by me in my role with The Foundation. \u201cConfidential Information\u201d means all information provided by myself, or information owned or developed, or non-public information conveyed by Dr. Vliet and The Foundation team of professionals relating to the comprehensive health services, faith and health programs and other services offered by the medical practices and The Foundation. Such Confidential Information includes, but is not limited to, factual information, proprietary treatment protocols and procedures, data, case studies, statistical analyses and models, interviews, profiles, business and financial plans, company policies, pricing, contracts, patient lists, consultant lists, discussions of hospitalized care, inpatient vs outpatient treatment options, treatment protocols\/algorithms and procedures, patent concepts and applications, software developed by or for The Foundation, marketing and promotional materials, products, health program content, and any future business or strategic plans for The Foundation.<\/p><\/div><\/div><div id=\"wpforms-3288-field_8-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"8\"><div id=\"wpforms-3288-field_8\"><p>I provide, I also agree that we shall mutually: <\/p><\/div><\/div><div id=\"wpforms-3288-field_9-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"9\"><div id=\"wpforms-3288-field_9\"><p>a) Protect and preserve the confidential and proprietary nature of all Confidential Information shared by either party;<\/p><\/div><\/div><div id=\"wpforms-3288-field_10-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"10\"><div id=\"wpforms-3288-field_10\"><p>b) Not disclose, give, sell or otherwise transfer or make available, directly or indirectly, any Confidential Information to any third party for any purpose; <\/p><\/div><\/div><div id=\"wpforms-3288-field_11-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"11\"><div id=\"wpforms-3288-field_11\"><p>c) Not use for commercial gain or any other purpose, or make any records or copies of, the Confidential Information, except as required for the performance of my discussions with or duties to The Foundation; <\/p><\/div><\/div><div id=\"wpforms-3288-field_12-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"12\"><div id=\"wpforms-3288-field_12\"><p>d) Limit the dissemination of the Confidential Information to such other employees or consultants of The Foundation whose duties justify the need to know the Confidential Information, and then only provided that there is a clear understanding by such individuals of their obligation to maintain the confidential and proprietary nature of the Confidential Information \u00a9Truth for Health Foundation 2021 www.TruthForHealth.org <\/p><\/div><\/div><div id=\"wpforms-3288-field_13-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"13\"><div id=\"wpforms-3288-field_13\"><p>e) Not disclose that The Foundation is performing services for the benefit of any individual patients or businesses except as otherwise mutually agreed by The Foundation and by me as agent for the patient; <\/p><\/div><\/div><div id=\"wpforms-3288-field_14-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"14\"><div id=\"wpforms-3288-field_14\"><p>f) Comply with any security procedures for patient confidentiality as may be required by The Foundation for protection of the Confidential Information. After the termination of my consulting with Dr. Vliet and The Foundation, both parties agree to return any retained Confidential Information if requested to do so. <\/p><\/div><\/div><div id=\"wpforms-3288-field_18-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"18\"><div id=\"wpforms-3288-field_18\"><p><strong>B. NON-SOLICITATION<\/strong><\/p><\/div><\/div><div id=\"wpforms-3288-field_15-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"15\"><div id=\"wpforms-3288-field_15\"><p>The following is a standard aspect of a mutual NDA, and while it may not be completely applicable to the referral and resources services requested, it remains a part of this agreement for the protection of both parties to this agreement, and in the event, there are future roles where this may apply. I agree that, upon the termination of my employment, advisory or service relationship with The Foundation for any reason, and for a period of five (3) years thereafter, I will not directly or indirectly: a) Solicit or accept, any client or team member who was, at any time during the one (1)-year period prior to ending this agreement, a client or team member of The Foundation; or b) Solicit, employ or engage as a consultant any person who was, at any time during the one-year period prior to my ending this agreement, an employee of The Foundation. c) Use for commercial gain or any other purpose or disclose to any other party any aspect of the Confidential Information learned during my association with The Company <\/p><\/div><\/div><div id=\"wpforms-3288-field_16-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"16\"><div id=\"wpforms-3288-field_16\"><p>C. REMEDY: I acknowledge that violation of these provisions will cause The Foundation irreparable harm and may be cause for separation or court actions against me. I agree to pay The Foundation any costs, damages, and any reasonable attorneys' fees incurred The Foundation if it prevails in enforcing the terms of this Agreement. <\/p><\/div><\/div><div id=\"wpforms-3288-field_17-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"17\"><div id=\"wpforms-3288-field_17\"><p>The Foundation, as represented by the authorized representative(s) signing this agreement, also commits to extend the same degree of confidentiality to the second party in this agreement.<\/p><\/div><\/div><div id=\"wpforms-3288-field_20-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"20\"><label class=\"wpforms-field-label\">Acceptance <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3288-field_20\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3288-field_20_1\" name=\"wpforms[fields][20][]\" value=\"I have read and accept all the terms of the Truth For Health Foundation&#039;s Confidentiality Agreement\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3288-field_20_1\">I have read and accept all the terms of the Truth For Health Foundation's Confidentiality Agreement<\/label><\/li><\/ul><\/div><div id=\"wpforms-3288-field_21-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"21\"><div id=\"wpforms-3288-field_21\"><p><i>Elizabeth Lee Vliet, MD<\/i><\/p>\r\n<p>Elizabeth Lee Vliet MD<\/p>\r\n<p>President\/CEO, Truth for Health Foundation<\/p><\/div><\/div><div id=\"wpforms-3288-field_23-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"23\"><div id=\"wpforms-3288-field_23\"><p><i>Nicole Landers<\/i><\/p>\r\n<p>Nicole Landers, RN, BSN, CCM, LNC<\/p>\r\n<p>Director, TFH MOBILE COVID CARE TEAM<\/p><\/div><\/div><div id=\"wpforms-3288-field_19-container\" class=\"wpforms-field wpforms-field-name font-style italic\" data-field-type=\"name\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-3288-field_19\">Electronic Signature <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3288-field_19\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][19]\" required><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"3288\"><input type=\"hidden\" name=\"wpforms[time_token]\" value=\"1792779471.6336dece623c49473750ea7b37869b214484679b6861641899cc9968ef12ebad\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/www.truthforhealth.org\/es\/wp-json\/wp\/v2\/pages\/1732\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-3288\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.truthforhealth.org\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n\n\n\n<ul class=\"wp-block-list\"><li><a href=\"http:\/\/www.truthforhealth.org\/wp-content\/uploads\/2022\/02\/ConfidentialityAgreement-TFH-POA.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">POA Confidentiality Form <\/a><\/li><\/ul>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"has-medium-font-size wp-block-paragraph\"> STEP 3 &#8211; Get Informed, and Review These Lifesaving Guides<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><a href=\"http:\/\/www.truthforhealth.org\/wp-content\/uploads\/2022\/02\/FACT-SHEET-STEPS-BEFORE-HOSPITALIZATION.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Steps Before Hospitalization Factsheet <\/a><\/li><li><a href=\"https:\/\/www.americanpatient.org\/aha-patients-bill-of-rights\/\" target=\"_blank\" rel=\"noreferrer noopener\">Patients Bill of Rights<\/a><ul><li><a href=\"http:\/\/www.truthforhealth.org\/wp-content\/uploads\/2022\/02\/Understanding-the-Patient-bill-of-rights.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Understanding the Patients Bill of Rights<\/a><\/li><\/ul><\/li><li><a href=\"https:\/\/www.truthforhealth.org\/2021\/09\/remdesivir-facts\/\" target=\"_blank\" rel=\"noreferrer noopener\">Remdesivir Facts<\/a><\/li><li><a href=\"http:\/\/www.truthforhealth.org\/wp-content\/uploads\/2022\/07\/TFH-FACT-SHEET-Merck-and-Pfizer-New-Oral-Antivirals-FINAL77802305843009244671373.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">TFH FACT SHEET &#8211; Merck and Pfizer New Oral Antivirals<\/a><\/li><li><a href=\"http:\/\/www.truthforhealth.org\/wp-content\/uploads\/2022\/07\/PAXLOVID-Patient-Eligibility-Screening-Checklist-Tool-for-Prescribers-07182022.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">PAXLOVID Patient Eligibility Screening Checklist Tool for Prescribers<\/a><\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"<p>The COVID Care Strategy Team rescues patients and families from hospitals. If you or someone you know is being involuntarily held and are risking loss of life by deadly hospital &hellip; <\/p>","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-1732","page","type-page","status-publish","hentry","fadeIn","image-hover-transition-effect","latest_post"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>COVID CARE STRATEGY TEAM - Truth for Health Foundation<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.truthforhealth.org\/es\/covid-care-strategy-team-2\/\" \/>\n<meta property=\"og:locale\" content=\"es_MX\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"COVID CARE STRATEGY TEAM - Truth for Health Foundation\" \/>\n<meta property=\"og:description\" content=\"The COVID Care Strategy Team rescues patients and families from hospitals. 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