{"id":904,"date":"2024-10-01T10:23:07","date_gmt":"2024-10-01T15:23:07","guid":{"rendered":"https:\/\/aurora.carmis.ai\/?page_id=904"},"modified":"2024-10-01T11:02:29","modified_gmt":"2024-10-01T16:02:29","slug":"newcomer-collaborative-community-mental-health-program-exchange-of-information-agreement","status":"publish","type":"page","link":"https:\/\/aurora.carmis.ai\/fr\/newcomer-collaborative-community-mental-health-program-exchange-of-information-agreement\/","title":{"rendered":"Accord d&#039;\u00e9change d&#039;informations sur le programme de collaboration communautaire en sant\u00e9 mentale pour les nouveaux arrivants"},"content":{"rendered":"<div id=\"cs-content\" class=\"cs-content\"><div class=\"x-section e904-e1 mp4-0 formbg\"><div class=\"x-row x-container max width e904-e2 mp4-1 mp4-2 innerformbg\"><div class=\"x-row-inner\"><div class=\"x-col e904-e3 mp4-3 NsdSpacerSmallAll\"><script>\nvar 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class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_7' id='gform_7'  action='\/fr\/wp-json\/wp\/v2\/pages\/904#gf_7' data-formid='7' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_7_10\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third CLIENT_UNQCODE exclude field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_7_10'>GUID<\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_7_10' type='text' value='' class='large'   tabindex='1'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_15\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third exclude field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_7_15'>reqCode<\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_7_15' type='text' value='' class='large'   tabindex='2'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_16\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-third F_413 exclude field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_7_16'>userEmail<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_16' id='input_7_16' type='email' value='' class='large' tabindex='3'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_7_9\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full START_DATE exclude field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_7_9'>Submission Date (Admin Only)<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_9' id='input_7_9' type='text' value='25\/06\/2026' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon' tabindex='4'  placeholder='dd\/mm\/yyyy' aria-describedby=\"input_7_9_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_7_9_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_7_9' class='gform_hidden' value='https:\/\/aurora.carmis.ai\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_7_1\" class=\"gfield gfield--type-text gfield--input-type-text F_404 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_7_1'>I hereby authorize (therapist&#039;s name):<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_7_1' type='text' value='' class='large'   tabindex='5'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_3\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full F_410 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_7_3'>and (other individual or agency):<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_7_3' type='text' value='' class='large'   tabindex='6'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_4\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full F_411 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_7_4'>to exchange written and verbal information concerning (client\u2019s name and birth date, please print):<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_7_4' type='text' value='' class='large'   tabindex='7'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_5\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full F_412 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_5'>Note: I direct my therapist not to discuss the following matters with the above-named individuals or agencies:<\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_7_5' type='text' value='' class='large'   tabindex='8'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_12\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><hr><\/div><fieldset id=\"field_7_11\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full F_403 gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_7_11'><div class='gchoice gchoice_7_11_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.1' type='checkbox'  value='&lt;span style=&quot;color:red&quot;&gt;*&lt;\/span&gt; I understand that this authorization expires in 90 days after the date following my signature or upon ending therapy.'  id='choice_7_11_1' tabindex='9'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_11_1' id='label_7_11_1' class='gform-field-label gform-field-label--type-inline'><span style=\"color:red\">*<\/span> I understand that this authorization expires in 90 days after the date following my signature or upon ending therapy.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_7_18\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-third D_401 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_7_18'>Date Signed<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_18' id='input_7_18' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon' tabindex='10'  placeholder='dd\/mm\/yyyy' aria-describedby=\"input_7_18_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_7_18_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_7_18' class='gform_hidden' value='https:\/\/aurora.carmis.ai\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_7_6\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third FIRST_NAME 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_7_6'>Full Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_7_6' type='text' value='' class='large' maxlength='100'  tabindex='11'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_7\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-third F_402 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_7_7'>Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><input type='hidden' value='' name='input_7' id='input_7_7_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_7_7_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><canvas id='input_7_7' width='300' height='180' style='border-style: 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