{"id":1454,"date":"2022-10-07T07:38:53","date_gmt":"2022-10-07T07:38:53","guid":{"rendered":"https:\/\/fe.desnet.id\/rsud_brebes\/?page_id=1454"},"modified":"2022-10-07T07:56:25","modified_gmt":"2022-10-07T07:56:25","slug":"form-permohonan-informasi","status":"publish","type":"page","link":"https:\/\/fe.desnet.online\/rsud_brebes\/form-permohonan-informasi\/","title":{"rendered":"Form Permohonan Informasi"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1454\" class=\"elementor elementor-1454\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-8bfc5bf elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"8bfc5bf\" data-element_type=\"section\" data-e-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-100 elementor-top-column elementor-element elementor-element-fbf6248\" data-id=\"fbf6248\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-596785d elementor-widget elementor-widget-text-editor\" data-id=\"596785d\" 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>Bagi pemohon diharuskan mengisi formulir pengajuan informasi yang ada dibawah ini. Formulir akan diterima oleh tim Informasi &amp; Pengaduan RSUD Brebes.<\/p>\t\t\t\t\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<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b0cde5d elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b0cde5d\" data-element_type=\"section\" data-e-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-100 elementor-top-column elementor-element elementor-element-30a8286\" data-id=\"30a8286\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2f77952 elementor-widget elementor-widget-shortcode\" data-id=\"2f77952\" 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\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-1461 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-1461\" data-uid=\"6a511fee24a0e\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-1461\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-1461 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"1461\"\n\t\t\t\t data-color-option=\"default\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6a511fee24a0e\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a511fee24a0e\" id=\"forminator-field-name-1_6a511fee24a0e-label\" class=\"forminator-label\">Nama Lengkap <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"Tulis Nama Anda\" id=\"forminator-field-name-1_6a511fee24a0e\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a511fee24a0e\" id=\"forminator-field-email-1_6a511fee24a0e-label\" class=\"forminator-label\">Email <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"Contoh : emailmu@email.com\" id=\"forminator-field-email-1_6a511fee24a0e\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6a511fee24a0e\" id=\"forminator-field-phone-1_6a511fee24a0e-label\" class=\"forminator-label\">No.Telephone <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"Tulis Nomor Telephone Anda\" id=\"forminator-field-phone-1_6a511fee24a0e\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" data-national_mode=\"enabled\" data-country=\"ID\" data-validation=\"standard\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6a511fee24a0e\" id=\"forminator-field-textarea-2_6a511fee24a0e-label\" class=\"forminator-label\">Alamat <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_6a511fee24a0e\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:70px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_6a511fee24a0e\" id=\"forminator-field-textarea-3_6a511fee24a0e-label\" class=\"forminator-label\">Rincian Informasi yg dibutuhkan <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_6a511fee24a0e\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-4\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-4_6a511fee24a0e\" id=\"forminator-field-textarea-4_6a511fee24a0e-label\" class=\"forminator-label\">Tujuan Penggunaan Informasi <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-4\" placeholder=\"\" id=\"forminator-field-textarea-4_6a511fee24a0e\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1461__field--select-1_6a511fee24a0e\" id=\"forminator-form-1461__field--select-1_6a511fee24a0e-label\" class=\"forminator-label\">Cara Memperoleh Informasi <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-1461__field--select-1_6a511fee24a0e\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-1\" data-default-value=\"\" data-placeholder=\"Pilih Cara Memperoleh Informasi\" data-search=\"false\" data-search-placeholder=\"Pilih Cara Memperoleh Informasi\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1461__field--select-1_6a511fee24a0e-label\"><option value=\"\"  >Pilih Cara Memperoleh Informasi<\/option><option value=\"Melihat\/ membaca \/ mendengarkan\/ mencatat\"  data-calculation=\"0\">Melihat\/ membaca \/ mendengarkan\/ mencatat<\/option><option value=\"Mendapatkan salinan informasi (hardcopy\/softcopy)\"  data-calculation=\"0\">Mendapatkan salinan informasi (hardcopy\/softcopy)<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-6a511fee24a0e-label\"><span id=\"forminator-radiogroup-radio-1-6a511fee24a0e-label\" class=\"forminator-label\">Cara Mendapatkan Salinan Informasi <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-6a511fee24a0e\" class=\"forminator-radio forminator-radio-inline\" title=\"Mengambil langsung\"><input type=\"radio\" name=\"radio-1\" value=\"Mengambil-langsung\" id=\"forminator-field-radio-1-1-6a511fee24a0e\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Mengambil langsung<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-6a511fee24a0e\" class=\"forminator-radio forminator-radio-inline\" title=\"Kurir\"><input type=\"radio\" name=\"radio-1\" value=\"Kurir\" id=\"forminator-field-radio-1-2-6a511fee24a0e\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Kurir<\/span><\/label><label id=\"forminator-field-radio-1-label-3\" for=\"forminator-field-radio-1-3-6a511fee24a0e\" class=\"forminator-radio forminator-radio-inline\" title=\"Pos\"><input type=\"radio\" name=\"radio-1\" value=\"Pos\" id=\"forminator-field-radio-1-3-6a511fee24a0e\" aria-labelledby=\"forminator-field-radio-1-label-3\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Pos<\/span><\/label><label id=\"forminator-field-radio-1-label-4\" for=\"forminator-field-radio-1-4-6a511fee24a0e\" class=\"forminator-radio forminator-radio-inline\" title=\"Fax\"><input type=\"radio\" name=\"radio-1\" value=\"Fax\" id=\"forminator-field-radio-1-4-6a511fee24a0e\" aria-labelledby=\"forminator-field-radio-1-label-4\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Fax<\/span><\/label><label id=\"forminator-field-radio-1-label-5\" for=\"forminator-field-radio-1-5-6a511fee24a0e\" class=\"forminator-radio forminator-radio-inline\" title=\"Email\"><input type=\"radio\" name=\"radio-1\" value=\"Email\" id=\"forminator-field-radio-1-5-6a511fee24a0e\" aria-labelledby=\"forminator-field-radio-1-label-5\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Email<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-6a511fee24a0e-label\"><label id=\"forminator-field-checkbox-1-1-6a511fee24a0e-label\" for=\"forminator-field-checkbox-1-1-6a511fee24a0e\" class=\"forminator-checkbox\" title=\"Informasi Yang Saya Masukkan Sudah Benar\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-1-6a511fee24a0e\" aria-labelledby=\"forminator-field-checkbox-1-1-6a511fee24a0e-label\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Informasi Yang Saya Masukkan Sudah Benar<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Kirim<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"9eac64dc17\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/rsud_brebes\/wp-json\/wp\/v2\/pages\/1454\" \/><input type=\"hidden\" name=\"form_id\" value=\"1461\"><input type=\"hidden\" name=\"page_id\" value=\"1454\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/fe.desnet.online\/rsud_brebes\/form-permohonan-informasi\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><label for=\"input_10\" class=\"forminator-hidden\" aria-hidden=\"true\">Please do not fill in this field. <input id=\"input_10\" type=\"text\" name=\"input_10\" value=\"\" autocomplete=\"off\"><\/label><\/form><\/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<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Bagi pemohon diharuskan mengisi formulir pengajuan informasi yang ada dibawah ini. Formulir akan diterima oleh tim Informasi &amp; Pengaduan RSUD Brebes.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-global-header-display":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","_joinchat":[],"footnotes":""},"class_list":["post-1454","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/fe.desnet.online\/rsud_brebes\/wp-json\/wp\/v2\/pages\/1454","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/fe.desnet.online\/rsud_brebes\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/fe.desnet.online\/rsud_brebes\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/fe.desnet.online\/rsud_brebes\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/fe.desnet.online\/rsud_brebes\/wp-json\/wp\/v2\/comments?post=1454"}],"version-history":[{"count":11,"href":"https:\/\/fe.desnet.online\/rsud_brebes\/wp-json\/wp\/v2\/pages\/1454\/revisions"}],"predecessor-version":[{"id":1467,"href":"https:\/\/fe.desnet.online\/rsud_brebes\/wp-json\/wp\/v2\/pages\/1454\/revisions\/1467"}],"wp:attachment":[{"href":"https:\/\/fe.desnet.online\/rsud_brebes\/wp-json\/wp\/v2\/media?parent=1454"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}