{"id":1509,"date":"2021-10-22T10:27:58","date_gmt":"2021-10-22T10:27:58","guid":{"rendered":"https:\/\/medicate.peacefulqode.com\/?page_id=1509"},"modified":"2023-08-16T18:00:42","modified_gmt":"2023-08-16T18:00:42","slug":"transfer-prescription","status":"publish","type":"page","link":"https:\/\/crisfieldpharmacy.net\/index.php\/transfer-prescription\/","title":{"rendered":"Transfer Prescription"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1509\" class=\"elementor elementor-1509\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-section elementor-top-section elementor-element elementor-element-0286a1a elementor-section-full_width elementor-section-stretched elementor-section-height-default elementor-section-height-default\" data-id=\"0286a1a\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-45b5330\" data-id=\"45b5330\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-section elementor-inner-section elementor-element elementor-element-99b090d elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"99b090d\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-inner-column elementor-element elementor-element-7d27a2a\" data-id=\"7d27a2a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-ac12603\" data-id=\"ac12603\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e0fd9bb elementor-widget elementor-widget-section-title\" data-id=\"e0fd9bb\" data-element_type=\"widget\" data-widget_type=\"section-title.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<div class=\"pt-section pt-style-1 text-\">\r\n\t\t\r\n   \t\t \r\n   \t\t<span class=\"pt-section-sub-title\">Rx transfer<\/span>\r\n   \t   \t\t\t   <h5 class=\"pt-section-title\" >Transfer Your Prescription<\/h5>\r\n\t\t\t\r\n<\/div>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-395ae42 pt-applyform-whitebg elementor-widget elementor-widget-shortcode\" data-id=\"395ae42\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f17312-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/1509#wpcf7-f17312-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"17312\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.8\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f17312-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<div class=\"pt-applyform\">\n\t<div class=\"row\">\n\t\t<h5> Patient Information\n\t\t<\/h5>\n\t\t<div class=\"col-md-6\">\n\t\t\t<p><label> Full Name<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Name\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"name\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Name\" \/><\/span> <\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-6\">\n\t\t\t<p><label> Date of Birth<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"DateOfBirth\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"DateOfBirth\" \/><\/span> <\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-6\">\n\t\t\t<p><label> Phone Number<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"PhoneNumber\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"PhoneNumber\" \/><\/span> <\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<h5>Prescription Information\n\t\t<\/h5>\n\t\t<div class=\"col-md-6\">\n\t\t\t<p><label> Current Pharmacy<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"CurrentPharmacy\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"CurrentPharmacy\" \/><\/span> <\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-6\">\n\t\t\t<p><label> Pharmacy Phone Number<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"PharmacyPhoneNumber\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"PharmacyPhoneNumber\" \/><\/span> <\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-6\">\n\t\t\t<p><label> Prescriptions Name(s)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"PrescriptionName\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"PrescriptionName\" \/><\/span> <\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-6\">\n\t\t\t<p><label> Rx Number(s)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"RxNumber\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"RxNumber\" \/><\/span> <\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"col-md-12\">\n\t\t<p><label> Message (optional)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Message\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control 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elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-139a1a8\" data-id=\"139a1a8\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-40a40eb elementor-widget elementor-widget-google_maps\" data-id=\"40a40eb\" data-element_type=\"widget\" data-widget_type=\"google_maps.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.15.0 - 09-08-2023 *\/\n.elementor-widget-google_maps .elementor-widget-container{overflow:hidden}.elementor-widget-google_maps .elementor-custom-embed{line-height:0}.elementor-widget-google_maps iframe{height:300px}<\/style>\t\t<div class=\"elementor-custom-embed\">\n\t\t\t<iframe loading=\"lazy\"\n\t\t\t\t\tsrc=\"https:\/\/maps.google.com\/maps?q=Crisfield%20Pharmacy%20390%20W%20Main%20St%20Unit-A%2C%20Crisfield%2C%20MD%2021817&#038;t=m&#038;z=14&#038;output=embed&#038;iwloc=near\"\n\t\t\t\t\ttitle=\"Crisfield Pharmacy 390 W Main St Unit-A, Crisfield, MD 21817\"\n\t\t\t\t\taria-label=\"Crisfield Pharmacy 390 W Main St Unit-A, Crisfield, MD 21817\"\n\t\t\t><\/iframe>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Rx transfer Transfer Your 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