{"id":348,"date":"2023-01-23T18:12:54","date_gmt":"2023-01-23T18:12:54","guid":{"rendered":"https:\/\/uabmedicine.org\/blogs\/greyform\/?page_id=348"},"modified":"2023-01-23T18:12:54","modified_gmt":"2023-01-23T18:12:54","slug":"bariatric-surgery-eligibility-form","status":"publish","type":"page","link":"https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/index.php\/bariatric-surgery-eligibility-form\/","title":{"rendered":"Bariatric Surgery Eligibility Form"},"content":{"rendered":"<script type=\"text\/javascript\">if(!gform){document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0});var gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),null==t&&(t=10),gform.hooks[o][n].push({tag:i,callable:r,priority:t})},doHook:function(o,n,r){if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[o][n]){var t,i=gform.hooks[o][n];i.sort(function(o,n){return o.priority-n.priority});for(var e=0;e<i.length;e++)\"function\"!=typeof(t=i[e].callable)&#038;&#038;(t=window[t]),\"action\"==o?t.apply(null,r):r[0]=t.apply(null,r)}if(\"filter\"==o)return r[0]},removeHook:function(o,n,r,t){if(null!=gform.hooks[o][n])for(var i=gform.hooks[o][n],e=i.length-1;0<=e;e--)null!=t&#038;&#038;t!=i[e].tag||null!=r&#038;&#038;r!=i[e].priority||i.splice(e,1)}}}<\/script>\n                <div class='gf_browser_gecko gform_wrapper gravity-theme' id='gform_wrapper_87' style='display:none'><div id='gf_87' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_87' id='gform_87'  action='\/blogs\/greyform\/index.php\/wp-json\/wp\/v2\/pages\/348#gf_87' novalidate>\n                        <div class='gform_body gform-body'><div id='gform_fields_87' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_87_56\" class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\" >Thank you for exploring weight loss (bariatric) surgery options at UAB Medicine. There are several factors to consider in determining if weight loss surgery may be right for you. If the following descriptions apply to you, then you may be a candidate.<\/br>\n<\/br>\nYou must be least 18 years old, and:<\/br><\/br>\n<strong>You Either:<\/strong>\n<ul>\n<li>Have a body mass index (BMI) of at least 40, or<\/li>\n<li>Have a BMI of 35 to 39 with obesity-related medical conditions, such as: <\/li> \n\t\t<ul>\n<li>Diabetes requiring medication <\/li> \n<li>Abnormal cholesterol, lipids, or triglycerides requiring medication<\/li>\n<li>Hypertension requiring medication<\/li>\n<li>Obstructive sleep apnea syndrome<\/li> \n<li>Severe osteoarthritis<\/li><\/ul>\n\t<\/ul>\n<strong>And:<\/strong>\n<ul>\n<li>You have tried to lose weight with diet and exercise but have been unsuccessful.<\/li>\n<li>You have been morbidly obese for at least three years.<\/li>\n<li>You are healthy and young enough to undergo surgery.<\/li>\n<li>You understand the surgical risks, benefits, and limitations of surgery, and how your life may change after surgery.<\/li>\n<\/ul>\n<strong>You do NOT have any of the following conditions:<\/strong>\n<ul>\n<li>Active peptic ulcer disease<\/li>\n<li>Alcoholism<\/li>\n<li>Drug abuse<\/li>\n<li>Serious psychiatric disability<\/li>\n<\/ul>\n\n<\/br>\n<\/br>Do you think weight loss surgery may be right for you? Take our brief assessment to find out.\n<\/div><div id=\"field_87_1\" class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\" ><script src=\u201dhttps:\/\/cdnjs.cloudflare.com\/ajax\/libs\/jquery\/3.3.1\/jquery.min.js\"><\/script>\n<script type=\"text\/javascript\">\njQuery(document).ready(function(){\n  jQuery('#input_125_50, #input_125_51, #input_125_52, #input_125_53, #input_125_55').on('change',function(){\n  var input1 = jQuery('#input_125_50').val();\n  var input2 = jQuery('#input_125_51').val();\n  var input3 = jQuery('#input_125_52').val();\nvar input4 = jQuery('#input_125_53').val(#input_51*12);\n var input5 = jQuery('#input_125_55').val(#input_52 + #input_53);\nvar input6 = jQuery('#input_125_54').val(input5*input5);\n    if(input1.length > 0 && input2.length > 0){\n    var result = 703*input1 \/ input6;\n   jQuery('.result').html('The result is '+result);\n   document.getElementById(\"bmiResults\").innerHTML = \"Your BMI is\" + result;\n}\n});\n \n});\n<\/script>\n<!--<div class=\"results\"><\/div>\n<div id=\"bmiResults\"><\/div>--><\/div><div id=\"field_87_50\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_87_50' >Weight<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_50' id='input_87_50' type='number' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_87_51\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_87_51' >Height (Feet)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_51' id='input_87_51' type='number' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_87_52\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_87_52' >Height (Inches)<\/label><div class='ginput_container ginput_container_number'><input name='input_52' id='input_87_52' type='number' step='any'   value='' class='medium'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_87_53\" class=\"gfield gfield_calculation field_sublabel_below field_description_above gfield_visibility_hidden\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label' for='input_87_53' >Converted Height<\/label><div class='gfield_description' id='gfield_description_87_53'>[TESTING. We will hide this field.]<\/div><div class='ginput_container ginput_container_number'><input name='input_53' id='input_87_53' type='text' step='any'   value='' class='medium'  readonly=\"readonly\"    aria-invalid=\"false\" aria-describedby=\"gfield_description_87_53\" \/><\/div><\/div><div id=\"field_87_55\" class=\"gfield gfield_calculation field_sublabel_below field_description_above gfield_visibility_hidden\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label' for='input_87_55' >Squared<\/label><div class='gfield_description' id='gfield_description_87_55'>[TESTING. We will hide this field.]<\/div><div class='ginput_container ginput_container_number'><input name='input_55' id='input_87_55' type='text' step='any'   value='' class='medium'  readonly=\"readonly\"    aria-invalid=\"false\" aria-describedby=\"gfield_description_87_55\" \/><\/div><\/div><div id=\"field_87_54\" class=\"gfield gfield_calculation field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_87_54' >Body Mass Index (BMI) Calculator<\/label><div class='ginput_container ginput_container_number'><input name='input_54' id='input_87_54' type='text' step='any'   value='' class='medium'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_87_19\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Do you suffer from obesity-related medical conditions such ase diabetes, obstructive sleep apnea syndrome, hypertension, or osteoarthritis requiring medication?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_87_19'>\n\t\t\t<div class='gchoice gchoice_87_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Yes'  id='choice_87_19_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_87_19_0' id='label_87_19_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_87_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='No'  id='choice_87_19_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_87_19_1' id='label_87_19_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_87' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_87\"]){return false;}  if( !jQuery(\"#gform_87\")[0].checkValidity || jQuery(\"#gform_87\")[0].checkValidity()){window[\"gf_submitting_87\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_87\"]){return false;} if( !jQuery(\"#gform_87\")[0].checkValidity || jQuery(\"#gform_87\")[0].checkValidity()){window[\"gf_submitting_87\"]=true;}  jQuery(\"#gform_87\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=87&amp;title=&amp;description=&amp;tabindex=0' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_87' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='87' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_87' value='WyJbXSIsImQ4OGVkZmY0NjE4YzNjYTY4YTYyNWRhMjJjNDUzY2JkIl0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_87' id='gform_target_page_number_87' value='0' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_87' id='gform_source_page_number_87' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>\n                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_87' id='gform_ajax_frame_87' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n                <script>\ngform.initializeOnLoaded( function() {gformInitSpinner( 87, 'https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/wp-content\/plugins\/gravityforms\/images\/spinner.svg' );jQuery('#gform_ajax_frame_87').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_87');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_87').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_87').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_87').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_87').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_87').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_87').val();gformInitSpinner( 87, 'https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/wp-content\/plugins\/gravityforms\/images\/spinner.svg' );jQuery(document).trigger('gform_page_loaded', [87, current_page]);window['gf_submitting_87'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_87').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_87').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [87]);window['gf_submitting_87'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_87').text());}, 50);}else{jQuery('#gform_87').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [87, current_page]);} );} );\n<\/script>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":5,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"\/web\/sites\/blogs\/greyform\/wp-content\/plugins\/uab-blank-page-templates\/templates\/uabmed-blank-template.php","meta":{"footnotes":""},"class_list":["post-348","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/index.php\/wp-json\/wp\/v2\/pages\/348","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/index.php\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/index.php\/wp-json\/wp\/v2\/comments?post=348"}],"version-history":[{"count":1,"href":"https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/index.php\/wp-json\/wp\/v2\/pages\/348\/revisions"}],"predecessor-version":[{"id":349,"href":"https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/index.php\/wp-json\/wp\/v2\/pages\/348\/revisions\/349"}],"wp:attachment":[{"href":"https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/index.php\/wp-json\/wp\/v2\/media?parent=348"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}