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.elementor-element.elementor-element-d9f46dd{--padding-top:20px;--padding-bottom:0px;--padding-left:20px;--padding-right:20px;}}</style>{"id":396,"date":"2023-07-31T21:11:34","date_gmt":"2023-08-01T04:11:34","guid":{"rendered":"http:\/\/sherifftest.venturacounty.gov\/?page_id=396"},"modified":"2024-02-02T18:06:31","modified_gmt":"2024-02-03T02:06:31","slug":"inmate-emergency-medical-notification-form","status":"publish","type":"page","link":"https:\/\/sherifftest.venturacounty.gov\/es\/inmate-information\/inmate-emergency-medical-notification-form\/","title":{"rendered":"Formulario de notificaci\u00f3n de emergencia m\u00e9dica para reclusos"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"396\" class=\"elementor elementor-396\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b8a496c e-flex e-con-boxed e-con e-parent\" data-id=\"b8a496c\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a7db847 elementor-widget elementor-widget-heading\" data-id=\"a7db847\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Inmate Emergency Medical Notification Form<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-d9f46dd e-flex e-con-boxed e-con e-parent\" data-id=\"d9f46dd\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-485cdd4 e-con-full e-flex e-con e-child\" data-id=\"485cdd4\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-94fe792 elementor-nav-menu--dropdown-tablet elementor-nav-menu__text-align-aside elementor-nav-menu--toggle elementor-nav-menu--burger elementor-widget elementor-widget-nav-menu\" data-id=\"94fe792\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;layout&quot;:&quot;vertical&quot;,&quot;submenu_icon&quot;:{&quot;value&quot;:&quot;&lt;i class=\\&quot;fas fa-caret-down\\&quot; aria-hidden=\\&quot;true\\&quot;&gt;&lt;\\\/i&gt;&quot;,&quot;library&quot;:&quot;fa-solid&quot;},&quot;toggle&quot;:&quot;burger&quot;}\" data-widget_type=\"nav-menu.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<nav aria-label=\"Menu\" class=\"elementor-nav-menu--main elementor-nav-menu__container elementor-nav-menu--layout-vertical e--pointer-background e--animation-fade\">\n\t\t\t\t<ul id=\"menu-1-94fe792\" class=\"elementor-nav-menu sm-vertical\"><li class=\"vMenu menu-item menu-item-type-post_type menu-item-object-page menu-item-416\"><a href=\"https:\/\/sherifftest.venturacounty.gov\/es\/inmate-information\/medical-mental-condition\/\" class=\"elementor-item\">Medical\/Mental Condition<\/a><\/li>\n<li class=\"vMenu menu-item menu-item-type-post_type menu-item-object-page menu-item-415\"><a href=\"https:\/\/sherifftest.venturacounty.gov\/es\/inmate-information\/mental-illness\/\" class=\"elementor-item\">Mental Illness<\/a><\/li>\n<li class=\"vMenu menu-item menu-item-type-post_type menu-item-object-page menu-item-414\"><a href=\"https:\/\/sherifftest.venturacounty.gov\/es\/inmate-information\/inmate-emergency-medical-notification-form\/\" class=\"elementor-item\">Inmate Emergency Medical Notification Form<\/a><\/li>\n<\/ul>\t\t\t<\/nav>\n\t\t\t\t\t<div class=\"elementor-menu-toggle\" role=\"button\" tabindex=\"0\" aria-label=\"Menu Toggle\" aria-expanded=\"false\">\n\t\t\t<i aria-hidden=\"true\" role=\"presentation\" class=\"elementor-menu-toggle__icon--open eicon-menu-bar\"><\/i><i aria-hidden=\"true\" role=\"presentation\" class=\"elementor-menu-toggle__icon--close eicon-close\"><\/i>\t\t<\/div>\n\t\t\t\t\t<nav class=\"elementor-nav-menu--dropdown elementor-nav-menu__container\" aria-hidden=\"true\">\n\t\t\t\t<ul id=\"menu-2-94fe792\" class=\"elementor-nav-menu sm-vertical\"><li class=\"vMenu menu-item menu-item-type-post_type menu-item-object-page menu-item-416\"><a href=\"https:\/\/sherifftest.venturacounty.gov\/es\/inmate-information\/medical-mental-condition\/\" class=\"elementor-item\" tabindex=\"-1\">Medical\/Mental Condition<\/a><\/li>\n<li class=\"vMenu menu-item menu-item-type-post_type menu-item-object-page menu-item-415\"><a href=\"https:\/\/sherifftest.venturacounty.gov\/es\/inmate-information\/mental-illness\/\" class=\"elementor-item\" tabindex=\"-1\">Mental Illness<\/a><\/li>\n<li class=\"vMenu menu-item menu-item-type-post_type menu-item-object-page menu-item-414\"><a href=\"https:\/\/sherifftest.venturacounty.gov\/es\/inmate-information\/inmate-emergency-medical-notification-form\/\" class=\"elementor-item\" tabindex=\"-1\">Inmate Emergency Medical Notification Form<\/a><\/li>\n<\/ul>\t\t\t<\/nav>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-9a80528 e-flex e-con-boxed e-con e-child\" data-id=\"9a80528\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e757c76 elementor-widget elementor-widget-text-editor\" data-id=\"e757c76\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>If you have an immediate concern about the health, and\/or well-being of an inmate in any of our Detention Facilities, please select English or Spanish form below:<\/p><p><strong>INMATE EMERGENCY NOTIFICATION FORM<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f681a5c e-n-tabs-mobile elementor-widget elementor-widget-n-tabs\" data-id=\"f681a5c\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;tabs_justify_horizontal&quot;:&quot;start&quot;,&quot;horizontal_scroll&quot;:&quot;disable&quot;}\" data-widget_type=\"nested-tabs.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"e-n-tabs\" data-widget-number=\"258480732\" aria-label=\"Pesta\u00f1as. Abre elementos con Intro o Espacio, ci\u00e9rralos con Escape y navega con las fechas.\">\n\t\t\t<div class=\"e-n-tabs-heading\" role=\"tablist\">\n\t\t\t\t\t<button id=\"e-n-tab-title-2584807321\" data-tab-title-id=\"e-n-tab-title-2584807321\" class=\"e-n-tab-title\" aria-selected=\"true\" data-tab-index=\"1\" role=\"tab\" tabindex=\"0\" aria-controls=\"e-n-tab-content-2584807321\" style=\"--n-tabs-title-order: 1;\">\n\t\t\t\t\t\t<span class=\"e-n-tab-title-text\">\n\t\t\t\tEnglish\t\t\t<\/span>\n\t\t<\/button>\n\t\t\t\t<button id=\"e-n-tab-title-2584807322\" data-tab-title-id=\"e-n-tab-title-2584807322\" class=\"e-n-tab-title\" aria-selected=\"false\" data-tab-index=\"2\" role=\"tab\" tabindex=\"-1\" aria-controls=\"e-n-tab-content-2584807322\" style=\"--n-tabs-title-order: 2;\">\n\t\t\t\t\t\t<span class=\"e-n-tab-title-text\">\n\t\t\t\tSpanish\t\t\t<\/span>\n\t\t<\/button>\n\t\t\t\t\t<\/div>\n\t\t\t<div class=\"e-n-tabs-content\">\n\t\t\t\t<div id=\"e-n-tab-content-2584807321\" role=\"tabpanel\" aria-labelledby=\"e-n-tab-title-2584807321\" data-tab-index=\"1\" style=\"--n-tabs-title-order: 1;\" class=\"e-active elementor-element elementor-element-9c071fd e-con-full e-flex e-con e-child\" data-id=\"9c071fd\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b34e2db elementor-widget elementor-widget-shortcode\" data-id=\"b34e2db\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><script>\nvar 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enctype='multipart\/form-data'  id='gform_9'  action='\/es\/wp-json\/wp\/v2\/pages\/396' data-formid='9' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LfWolspAAAAAAobxZ4pE5EldYtiqOFotUi3svVG' data-tabindex='0'><input id=\"input_c1be3d2d2cc66e3cd85c0c31fd627f8c\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_c1be3d2d2cc66e3cd85c0c31fd627f8c\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_9_12\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_12'><span class='gform-field-label__text'>Phone<\/span><\/label><div class='ginput_container'><input name='input_12' id='input_9_12' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_9_12'>This field is for validation purposes and should be left unchanged.<\/div><\/div><div id=\"field_9_7\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Inmate Information<\/h3><\/div><fieldset id=\"field_9_1\" class=\"gfield gfield--type-name gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Inmate Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_1'>\n                            \n                            <span id='input_9_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_9_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_9_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_9_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_9_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_9_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_3\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_3'><span class='gform-field-label__text'>Booking Number<\/span><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_3' id='input_9_3' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_9_4\" class=\"gfield gfield--type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_4'><span class='gform-field-label__text'>Facility<\/span><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_4' id='input_9_4' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Pre-Trial Detention Facility' >Pre-Trial Detention Facility<\/option><option value='Todd Road Jail' >Todd Road Jail<\/option><option value='East Valley Jail' >East Valley Jail<\/option><\/select><\/div><\/div><div id=\"field_9_5\" class=\"gfield gfield--type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_5'><span class='gform-field-label__text'>Type of Inmate Emergency Issue Being Reported<\/span><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_9_5' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Sexual Assault or Sexual Harassment' >Sexual Assault or Sexual Harassment<\/option><option value='Medical' >Medical<\/option><option value='Suicidal' >Suicidal<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_9_8\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Your Information<\/h3><\/div><fieldset id=\"field_9_6\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Your Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_6'>\n                            \n                            <span id='input_9_6_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_6.3' id='input_9_6_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_9_6_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_9_6_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_6.6' id='input_9_6_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_9_6_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_9_9\" class=\"gfield gfield--type-phone gfield--phone-format-international gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_9'><span class='gform-field-label__text'>Phone<\/span><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_9' id='input_9_9' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_9_11\" class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_11'><span class='gform-field-label__text'>Email<\/span><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_11' id='input_9_11' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_9_10\" class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_10'><span class='gform-field-label__text'>Describe the issue being reported<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_10' id='input_9_10' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_9' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_9' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_9' id='gform_theme_9' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_9' id='gform_style_settings_9' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_9' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='9' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='O1leRLJLyR1Z5oQpfC2jEOR5XO3Mbekb2axStHfZ0ycszmez6L90qx1Ui2+icWXuGDfL9LunnghBTNRZPxgjH10zjeRYlK0E1QxiHPFmZrCKLVI=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_9' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_9' id='gform_target_page_number_9' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_9' id='gform_source_page_number_9' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div id=\"e-n-tab-content-2584807322\" role=\"tabpanel\" aria-labelledby=\"e-n-tab-title-2584807322\" data-tab-index=\"2\" style=\"--n-tabs-title-order: 2;\" class=\" elementor-element elementor-element-004a34d e-con-full e-flex e-con e-child\" data-id=\"004a34d\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2f07b99 elementor-widget elementor-widget-shortcode\" data-id=\"2f07b99\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_10' >\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_10'  action='\/es\/wp-json\/wp\/v2\/pages\/396' data-formid='10' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LfWolspAAAAAAobxZ4pE5EldYtiqOFotUi3svVG' data-tabindex='0'><input id=\"input_42285b71e9989e0d1c1db7eeb502e71f\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_42285b71e9989e0d1c1db7eeb502e71f\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_10' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_10_12\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_12'><span class='gform-field-label__text'>Name<\/span><\/label><div class='ginput_container'><input name='input_12' id='input_10_12' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_10_12'>This field is for validation purposes and should be left unchanged.<\/div><\/div><div id=\"field_10_7\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Informaci\u00f3n del recluso<\/h3><\/div><fieldset id=\"field_10_1\" class=\"gfield gfield--type-name gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nombre del preso:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_1'>\n                            \n                            <span id='input_10_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_10_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_10_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_10_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_10_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_3\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_3'><span class='gform-field-label__text'>Booking Number<\/span><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_3' id='input_10_3' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_4\" class=\"gfield gfield--type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_4'><span class='gform-field-label__text'>Instalaci\u00f3n:<\/span><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_4' id='input_10_4' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Pre-Trial Detention Facility' >Pre-Trial Detention Facility<\/option><option value='Todd Road Jail' >Todd Road Jail<\/option><option value='East Valley Jail' >East Valley Jail<\/option><\/select><\/div><\/div><div id=\"field_10_5\" class=\"gfield gfield--type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_5'><span class='gform-field-label__text'>Tipo de problema de emergencia del recluso que se informa:<\/span><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_10_5' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Agresi\u00f3n sexual\/acoso sexual' >Agresi\u00f3n sexual\/acoso sexual<\/option><option value='M\u00e9dico' >M\u00e9dico<\/option><option value='Suicida' >Suicida<\/option><option value='Otro' >Otro<\/option><\/select><\/div><\/div><div id=\"field_10_8\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Tu informaci\u00f3n<\/h3><\/div><fieldset id=\"field_10_6\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nombre<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_6'>\n                            \n                            <span id='input_10_6_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_6.3' id='input_10_6_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_10_6_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_6_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_6.6' id='input_10_6_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_10_6_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_9\" class=\"gfield gfield--type-phone gfield--phone-format-international gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_9'><span class='gform-field-label__text'>N\u00famero de tel\u00e9fono<\/span><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_9' id='input_10_9' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_10_11\" class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_11'><span class='gform-field-label__text'>Tu correo electr\u00f3nico<\/span><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_11' id='input_10_11' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_10_10\" class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_10'><span class='gform-field-label__text'>Describa el problema del que se informa:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_10' id='input_10_10' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_10' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >enviar<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_10' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_10' id='gform_theme_10' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_10' id='gform_style_settings_10' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_10' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='10' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='98fHzI0N6pzYEHFQwA1zaBV+8khIeN1DnfhQivJXcr6dxyNvwn1qlg+oQjwmCKGn4h8+ZNYHc5K+TfMJ4KSukJxUWv\/raPKBWDfpt4OWtPaLQ0w=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_10' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_10' id='gform_target_page_number_10' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_10' id='gform_source_page_number_10' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div><\/div>\n\t\t\t\t\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<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>If you have an immediate concern about the health, and\/or well-being of an inmate in any of our Detention Facilities, please select English or Spanish form below: INMATE EMERGENCY NOTIFICATION FORM English Spanish Inmate Information Inmate Name(Required) First Last Booking Number(Required) Facility(Required)Pre-Trial Detention FacilityTodd Road JailEast Valley JailType of Inmate Emergency Issue Being Reported(Required)Sexual Assault 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