{"id":84,"date":"2022-06-29T18:29:56","date_gmt":"2022-06-29T18:29:56","guid":{"rendered":"https:\/\/uabmedicine.org\/blogs\/greyform\/?page_id=84"},"modified":"2023-02-06T18:24:40","modified_gmt":"2023-02-06T18:24:40","slug":"clinical-simulation-equipment-loan-request","status":"publish","type":"page","link":"https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/index.php\/clinical-simulation-equipment-loan-request\/","title":{"rendered":"Clinical Simulation Equipment Loan Request"},"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_17' style='display:none'><div id='gf_17' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_17' id='gform_17'  action='\/blogs\/greyform\/index.php\/wp-json\/wp\/v2\/pages\/84#gf_17' novalidate>\n                        <div class='gform_body gform-body'><div id='gform_fields_17' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_17_1\" class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\" ><p class=\"lead\">Please complete this form if you are interested in borrowing simulation equipment.<\/p>\n<p>\nWe need at least 24 hours to prepare your equipment loan. You will receive an email asking for clarification or confirming your loan from <a href=\"simulation@uabmc.edu\">simulation@uabmc.edu<\/a> within 24 business hours. If you need your loan before noon of the next business day, we may not be able to fulfill your request.<\/p>\n<p>If you have questions about simulation events or scheduling, please email <a href=\" simulation@uabmc.edu\">simulation@uabmc.edu<\/a> directly.<\/p>\n<\/div><fieldset id=\"field_17_2\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_17_2'>\n                            \n                            <span id='input_17_2_3_container' class='name_first' >\n                                                    <input type='text' name='input_2.3' id='input_17_2_3' value='' aria-label='First name'   aria-required='true'     \/>\n                                                    <label for='input_17_2_3' >First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_17_2_6_container' class='name_last' >\n                                                    <input type='text' name='input_2.6' id='input_17_2_6' value='' aria-label='Last name'   aria-required='true'     \/>\n                                                    <label for='input_17_2_6' >Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_17_3\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_17_3' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_3' id='input_17_3' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_17_4\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_17_4' >Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_17_4' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_5\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below 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_17_5' >Location<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_5' id='input_17_5' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select from the options below<\/option><option value='UAB Hospital' >UAB Hospital<\/option><option value='UAB Highlands' >UAB Highlands<\/option><option value='UAB Campus' >UAB Campus<\/option><option value='UAB Alliance Facility' >UAB Alliance Facility<\/option><option value='Alabama Rural Health Collaborative Facility' >Alabama Rural Health Collaborative Facility<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_17_7\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_17_7' >BlazerID<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_17_7' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_17_8\" class=\"gfield field_sublabel_below field_description_below 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_17_8' >ARHC Hospital<\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_17_8' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_17_9\" class=\"gfield field_sublabel_below field_description_below 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_17_9' >Please specify<\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_17_9' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_17_11\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_hidden\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><legend class='gfield_label gfield_label_before_complex'  >Requested Item (Please use the + sign to add more items. You can add up to three items.)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_list ginput_list'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header\"><div class=\"gfield_header_item\">Requested Item<\/div><div class=\"gfield_header_item\">Quantity Needed<\/div><div class=\"gfield_header_item\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group'><div class='gfield_list_group_item gfield_list_cell gfield_list_11_cell1' data-label='Requested Item'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_17_11\" aria-label='Requested Item, Row 1' data-aria-label-template='Requested Item, Row {0}' type='text' name='input_11[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_11_cell2' data-label='Quantity Needed'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_17_11\" aria-label='Quantity Needed, Row 1' data-aria-label-template='Quantity Needed, Row {0}' type='text' name='input_11[]' value=''   \/><\/div><div class='gfield_list_icons'>   <button type=\"button\"  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 3)'>Add<\/button>   <button type=\"button\"  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 3)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><div class='gfield_description' id='gfield_description_17_11'>What equipment do you need to borrow for your event? \n\nIf you run out of space or need more than 3 items, please put additional equipment in the Comment box. Please note that whole body manikins need to remain in the simulation lab. <\/div><\/fieldset><div id=\"field_17_12\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below 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_17_12' >Event Name\/Class<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_17_12' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_17_19\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_17_19' >What equipment do you need to borrow?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_17_19' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_17_20\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_17_20' >Please describe how you are going to use it.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_17_20' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_17_13\" class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_17_13' >Pick Up  Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_13' id='input_17_13' type='text' value='' class='datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_17_13_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_17_13_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_17_13' class='gform_hidden' value='https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_17_15\" class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_17_15' >Return Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_15' id='input_17_15' type='text' value='' class='datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_17_15_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_17_15_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_17_15' class='gform_hidden' value='https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_17_17\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_17_17' >Comments<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_17' id='input_17_17' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_17_18\" class=\"gfield gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_17_18'>Borrower is responsible for the safe use of the equipment and for any damages.<br \/>\n<br \/>\nBorrower will communicate any changes in pick-up or return dates of equipment to <a 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