{"id":6799,"date":"2026-05-29T09:23:14","date_gmt":"2026-05-29T14:23:14","guid":{"rendered":"https:\/\/vetaffairs.la.gov\/?page_id=6799"},"modified":"2026-05-29T09:23:14","modified_gmt":"2026-05-29T14:23:14","slug":"mau-don-bay-to-su-quan-tam-den-nha-o-danh-cho-cuu-chien-binh","status":"publish","type":"page","link":"https:\/\/vetaffairs.la.gov\/vi\/veteran-home-interest-form","title":{"rendered":"M\u1eabu \u0111\u01a1n b\u00e0y t\u1ecf s\u1ef1 quan t\u00e2m \u0111\u1ebfn nh\u00e0 \u1edf d\u00e0nh cho c\u1ef1u chi\u1ebfn binh"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform-theme gform-theme--foundation gform-theme--framework gform-theme--orbital veterans-home-interest-form_wrapper' data-form-theme='orbital' data-form-index='0' id='gform_wrapper_15' style='display:none'><style>#gform_wrapper_15[data-form-index=\"0\"].gform-theme,[data-parent-form=\"15_0\"]{--gf-color-primary: #204ce5;--gf-color-primary-rgb: 32, 76, 229;--gf-color-primary-contrast: #fff;--gf-color-primary-contrast-rgb: 255, 255, 255;--gf-color-primary-darker: #001AB3;--gf-color-primary-lighter: #527EFF;--gf-color-secondary: #fff;--gf-color-secondary-rgb: 255, 255, 255;--gf-color-secondary-contrast: #112337;--gf-color-secondary-contrast-rgb: 17, 35, 55;--gf-color-secondary-darker: #F5F5F5;--gf-color-secondary-lighter: #FFFFFF;--gf-color-out-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-out-ctrl-light-rgb: 17, 35, 55;--gf-color-out-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-out-ctrl-light-lighter: #F5F5F5;--gf-color-out-ctrl-dark: #585e6a;--gf-color-out-ctrl-dark-rgb: 88, 94, 106;--gf-color-out-ctrl-dark-darker: #112337;--gf-color-out-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-color-in-ctrl: #fff;--gf-color-in-ctrl-rgb: 255, 255, 255;--gf-color-in-ctrl-contrast: #112337;--gf-color-in-ctrl-contrast-rgb: 17, 35, 55;--gf-color-in-ctrl-darker: #F5F5F5;--gf-color-in-ctrl-lighter: #FFFFFF;--gf-color-in-ctrl-primary: #204ce5;--gf-color-in-ctrl-primary-rgb: 32, 76, 229;--gf-color-in-ctrl-primary-contrast: #fff;--gf-color-in-ctrl-primary-contrast-rgb: 255, 255, 255;--gf-color-in-ctrl-primary-darker: #001AB3;--gf-color-in-ctrl-primary-lighter: #527EFF;--gf-color-in-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-in-ctrl-light-rgb: 17, 35, 55;--gf-color-in-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-in-ctrl-light-lighter: #F5F5F5;--gf-color-in-ctrl-dark: #585e6a;--gf-color-in-ctrl-dark-rgb: 88, 94, 106;--gf-color-in-ctrl-dark-darker: #112337;--gf-color-in-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-radius: 3px;--gf-font-size-secondary: 14px;--gf-font-size-tertiary: 13px;--gf-icon-ctrl-number: url(\"data:image\/svg+xml,%3Csvg width='8' height='14' viewBox='0 0 8 14' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M4 0C4.26522 5.96046e-08 4.51957 0.105357 4.70711 0.292893L7.70711 3.29289C8.09763 3.68342 8.09763 4.31658 7.70711 4.70711C7.31658 5.09763 6.68342 5.09763 6.29289 4.70711L4 2.41421L1.70711 4.70711C1.31658 5.09763 0.683417 5.09763 0.292893 4.70711C-0.0976311 4.31658 -0.097631 3.68342 0.292893 3.29289L3.29289 0.292893C3.48043 0.105357 3.73478 0 4 0ZM0.292893 9.29289C0.683417 8.90237 1.31658 8.90237 1.70711 9.29289L4 11.5858L6.29289 9.29289C6.68342 8.90237 7.31658 8.90237 7.70711 9.29289C8.09763 9.68342 8.09763 10.3166 7.70711 10.7071L4.70711 13.7071C4.31658 14.0976 3.68342 14.0976 3.29289 13.7071L0.292893 10.7071C-0.0976311 10.3166 -0.0976311 9.68342 0.292893 9.29289Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-select: url(\"data:image\/svg+xml,%3Csvg width='10' height='6' viewBox='0 0 10 6' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M0.292893 0.292893C0.683417 -0.097631 1.31658 -0.097631 1.70711 0.292893L5 3.58579L8.29289 0.292893C8.68342 -0.0976311 9.31658 -0.0976311 9.70711 0.292893C10.0976 0.683417 10.0976 1.31658 9.70711 1.70711L5.70711 5.70711C5.31658 6.09763 4.68342 6.09763 4.29289 5.70711L0.292893 1.70711C-0.0976311 1.31658 -0.0976311 0.683418 0.292893 0.292893Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-search: url(\"data:image\/svg+xml,%3Csvg width='640' height='640' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath d='M256 128c-70.692 0-128 57.308-128 128 0 70.691 57.308 128 128 128 70.691 0 128-57.309 128-128 0-70.692-57.309-128-128-128zM64 256c0-106.039 85.961-192 192-192s192 85.961 192 192c0 41.466-13.146 79.863-35.498 111.248l154.125 154.125c12.496 12.496 12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style><div id='gf_15' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <p class='gform_description'><div class=\"gf-logic-announcer sr-only\" aria-live=\"polite\">placeholder<\/div><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_15' id='gform_15' class='veterans-home-interest-form' action='\/vi\/wp-json\/wp\/v2\/pages\/6799#gf_15' data-formid='15' novalidate>\t\t\t\t\t<div style=\"display: none !important;\" class=\"akismet-fields-container gf_invisible\" data-prefix=\"ak_\">\n\t\t\t\t\t\t<label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label>\n\t\t\t\t\t\t<input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"203\" \/>\n\t\t\t\t\t\t<script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n\n\t\t\t\t\t<\/div><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LfaguwrAAAAAD1Ru0fYnu0M-b2rk9WNME9ICeAJ' data-tabindex='0'><input id=\"input_4c80892ff0f822fe0a44d9d3abb0470e\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_4c80892ff0f822fe0a44d9d3abb0470e\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_15' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_15_59\" 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\"  ><h2>Apply here:<\/h2><\/div><fieldset id=\"field_15_3\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full form-choice-buttons 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' >Who is interested in admission to a Louisiana State Veterans Home?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_15_3'>\n\t\t\t<div class='gchoice gchoice_15_3_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Veteran'  id='choice_15_3_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_3_0' id='label_15_3_0' class='gform-field-label gform-field-label--type-inline'>Veteran<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_15_3_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Spouse of a Veteran'  id='choice_15_3_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_3_1' id='label_15_3_1' class='gform-field-label gform-field-label--type-inline'>Spouse of a Veteran<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_15_3_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Gold Star Parent'  id='choice_15_3_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_3_2' id='label_15_3_2' class='gform-field-label gform-field-label--type-inline'>Gold Star Parent<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_15_3_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Louisiana National Guard\/Reservist Member'  id='choice_15_3_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_3_3' id='label_15_3_3' class='gform-field-label gform-field-label--type-inline'>Louisiana National Guard\/Reservist Member<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_15_60\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full cemetery-choice 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' >Please select your preferred home:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_15_60'>\n\t\t\t<div class='gchoice gchoice_15_60_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='Louisiana Veterans Home (Jackson)'  id='choice_15_60_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_60_0' id='label_15_60_0' class='gform-field-label gform-field-label--type-inline'>Louisiana Veterans Home (Jackson)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_15_60_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='Northeast Louisiana Veterans Home (Monroe)'  id='choice_15_60_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_60_1' id='label_15_60_1' class='gform-field-label gform-field-label--type-inline'>Northeast Louisiana Veterans Home (Monroe)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_15_60_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='Northwest Louisiana Veterans Home (Bossier City)'  id='choice_15_60_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_60_2' id='label_15_60_2' class='gform-field-label gform-field-label--type-inline'>Northwest Louisiana Veterans Home (Bossier City)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_15_60_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='Southeast Louisiana Veterans Home (Reserve)'  id='choice_15_60_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_60_3' id='label_15_60_3' class='gform-field-label gform-field-label--type-inline'>Southeast Louisiana Veterans Home (Reserve)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_15_60_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='Southwest Louisiana Veterans Home (Jennings)'  id='choice_15_60_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_60_4' id='label_15_60_4' class='gform-field-label gform-field-label--type-inline'>Southwest Louisiana Veterans Home (Jennings)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_15_4\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full section-title gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2>Applicant Information<\/h2><\/div><fieldset id=\"field_15_1\" class=\"gfield gfield--type-name gfield--input-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' >Name<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 has_middle_name has_last_name has_suffix gf_name_has_4 ginput_container_name gform-grid-row' id='input_15_1'>\n                            \n                            <span id='input_15_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_15_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_15_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            <span id='input_15_1_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.4' id='input_15_1_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_15_1_4' class='gform-field-label gform-field-label--type-sub '>Middle<\/label>\n                                                <\/span>\n                            <span id='input_15_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_15_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_15_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            <span id='input_15_1_8_container' class='name_suffix  gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.8' id='input_15_1_8' value=''   aria-required='false'     \/>\n                                                    <label for='input_15_1_8' class='gform-field-label gform-field-label--type-sub '>Suffix<\/label>\n                                                <\/span>\n                        <\/div><\/fieldset><div id=\"field_15_7\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_15_7'>Last 4 digits of Social Security Number<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_15_7' type='text' value='' class='large'  aria-describedby=\"gfield_description_15_7\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_15_7'>Format: 6789<\/div><\/div><div id=\"field_15_9\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_15_9'>Date of Birth<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_9' id='input_15_9' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_15_9_date_format gfield_description_15_9\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_15_9_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_15_9' class='gform_hidden' value='https:\/\/vetaffairs.la.gov\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_15_9'>Format: mm\/dd\/yyyy<\/div><\/div><div id=\"field_15_19\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_15_19'>Veteran&#039;s Branch of Service<\/label><div class='ginput_container ginput_container_select'><select name='input_19' id='input_15_19' class='large gfield_select'     aria-invalid=\"false\" ><option value='Army' >Army<\/option><option value='Marine Corps' >Marine Corps<\/option><option value='Navy' >Navy<\/option><option value='Air Force' >Air Force<\/option><option value='Space Force' >Space Force<\/option><option value='Coast Guard' >Coast Guard<\/option><option value='National Guard\/Reserve' >National Guard\/Reserve<\/option><\/select><\/div><\/div><fieldset id=\"field_15_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full if-married-buttons 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' >Does the applicant live in Louisiana<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_15_14'>\n\t\t\t<div class='gchoice gchoice_15_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Yes'  id='choice_15_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_14_0' id='label_15_14_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_15_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='No'  id='choice_15_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_14_1' id='label_15_14_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_15_53\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_15_53'>City<\/label><div class='ginput_container ginput_container_text'><input name='input_53' id='input_15_53' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_15_54\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_15_54'>Parish\/County<\/label><div class='ginput_container ginput_container_text'><input name='input_54' id='input_15_54' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_15_55\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_15_55'>State<\/label><div class='ginput_container ginput_container_text'><input name='input_55' id='input_15_55' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_15_52\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_15_52'>Zipcode<\/label><div class='ginput_container ginput_container_text'><input name='input_52' id='input_15_52' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_15_57\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half buried-buttons 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' >Where does the applicant currently reside?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_15_57'>\n\t\t\t<div class='gchoice gchoice_15_57_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='Own Home'  id='choice_15_57_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_57_0' id='label_15_57_0' class='gform-field-label gform-field-label--type-inline'>Own Home<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_15_57_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='Home of Family Member\/Friend'  id='choice_15_57_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_57_1' id='label_15_57_1' class='gform-field-label gform-field-label--type-inline'>Home of Family Member\/Friend<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_15_57_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='Nursing Home (if so provide name in next block)'  id='choice_15_57_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_57_2' id='label_15_57_2' class='gform-field-label gform-field-label--type-inline'>Nursing Home (if so provide name in next block)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_15_57_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='Hospital (if so provide name in next block)'  id='choice_15_57_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_57_3' id='label_15_57_3' class='gform-field-label gform-field-label--type-inline'>Hospital (if so provide name in next block)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_15_58\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_15_58'>If nursing home or hospital, please enter name<\/label><div class='ginput_container ginput_container_text'><input name='input_58' id='input_15_58' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_15_26\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-two-thirds crime-buttons 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' >Does the applicant have any previous criminal convictions or open criminal charges?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_15_26'>\n\t\t\t<div class='gchoice gchoice_15_26_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Yes'  id='choice_15_26_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_26_0' id='label_15_26_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_15_26_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='No'  id='choice_15_26_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_26_1' id='label_15_26_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_15_25\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_15_25'>If yes, provide a brief explanation:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_25' id='input_15_25' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_15_44\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full spouse-burial-buttons 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' >Is applicant required to register as a sex offender?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_15_44'>\n\t\t\t<div class='gchoice gchoice_15_44_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='Yes'  id='choice_15_44_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_44_0' id='label_15_44_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_15_44_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='No'  id='choice_15_44_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_15_44_1' id='label_15_44_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_15_15\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full section-title gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2>Applicant Representative Information (only if form not being filled by applicant.)<\/h2><\/div><fieldset id=\"field_15_16\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full 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' >Name of person completing form if not applicant<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name has_suffix gf_name_has_4 ginput_container_name gform-grid-row' id='input_15_16'>\n                            \n                            <span id='input_15_16_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.3' id='input_15_16_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_15_16_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            <span id='input_15_16_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.4' id='input_15_16_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_15_16_4' class='gform-field-label gform-field-label--type-sub '>Middle<\/label>\n                                                <\/span>\n                            <span id='input_15_16_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.6' id='input_15_16_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_15_16_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            <span id='input_15_16_8_container' class='name_suffix  gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.8' id='input_15_16_8' value=''   aria-required='false'     \/>\n                                                    <label for='input_15_16_8' class='gform-field-label gform-field-label--type-sub '>Suffix<\/label>\n                                                <\/span>\n                        <\/div><\/fieldset><div id=\"field_15_32\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_15_32'>Family Contact Name<\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_15_32' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_15_37\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_15_37'>Relationship<\/label><div class='ginput_container ginput_container_select'><select name='input_37' id='input_15_37' class='large gfield_select'     aria-invalid=\"false\" ><option value='Spouse' >Spouse<\/option><option value='Son' >Son<\/option><option value='Daughter' >Daughter<\/option><option value='Mother' >Mother<\/option><option value='Father' >Father<\/option><option value='Sibling' >Sibling<\/option><option value='Next of Kin' >Next of Kin<\/option><\/select><\/div><\/div><div id=\"field_15_30\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_15_30'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_30' id='input_15_30' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_15_30\"  \/><\/div><div class='gfield_description' id='gfield_description_15_30'>Format: (123) 456-7890<\/div><\/div><div id=\"field_15_31\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_15_31'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_31' id='input_15_31' type='email' value='' class='large'     aria-invalid=\"false\" aria-describedby=\"gfield_description_15_31\" \/>\n                        <\/div><div class='gfield_description' id='gfield_description_15_31'>Format: sample@domain.com<\/div><\/div><div id=\"field_15_63\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_15_63'>Please attach a copy of the veteran&#039;s Discharge Documents (DD-214, Retirement ID Card, etc.) if available.<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_15_63' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_15_63&quot;,&quot;container&quot;:&quot;gform_multifile_upload_15_63&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_15_63&quot;,&quot;filelist&quot;:&quot;gform_preview_15_63&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/?gf_page=3e476ed529d9fa4&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;pdf,jpg&quot;}],&quot;max_file_size&quot;:&quot;134217728b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:15,&quot;field_id&quot;:63,&quot;_gform_file_upload_nonce_15_63&quot;:&quot;3427d87be1&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_15_63&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_15_63' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_15_63' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_15_63 gfield_description_15_63\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_15_63'>Accepted file types: pdf, jpg, Max. file size: 128 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_15_63'><\/ul> <div id='gform_preview_15_63' class='ginput_preview_list'><\/div><\/div><div class='gfield_description' id='gfield_description_15_63'>Any information we will need to determine eligibility<\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_15' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> <input type='hidden' name='gform_ajax' value='form_id=15&amp;title=&amp;description=1&amp;tabindex=0&amp;theme=orbital&amp;styles=[]&amp;hash=c83493d35b837b9f757fa41437d05fb9' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_15' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_15' id='gform_theme_15' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_15' id='gform_style_settings_15' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_15' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='15' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='kMa+Z4mZRnfvEUi4SYUpsduJFT6BLlzI3I9ymVAnd42pRS9qh7tE8ljjjvRBuxLeaSJolkpdDFHpsCKJFcEnPPkEJPFhdoc\/9rm9yt69L8q0lCY=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_15' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_15' id='gform_target_page_number_15' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_15' id='gform_source_page_number_15' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            <input type='hidden' name='gform_uploaded_files' id='gform_uploaded_files_15' value='' \/>\n        <\/div>\n                        <\/form>\n                        <\/div>\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_15' id='gform_ajax_frame_15' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n\t\t                <script>\ngform.initializeOnLoaded( function() {gformInitSpinner( 15, 'https:\/\/vetaffairs.la.gov\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', false );jQuery('#gform_ajax_frame_15').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_15');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_15').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){form_content.find('form').css('opacity', 0);jQuery('#gform_wrapper_15').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_15').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_15').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_15').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_15').val();gformInitSpinner( 15, 'https:\/\/vetaffairs.la.gov\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', false );jQuery(document).trigger('gform_page_loaded', [15, current_page]);window['gf_submitting_15'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_15').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_15').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [15]);window['gf_submitting_15'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_15').text());}else{jQuery('#gform_15').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"15\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_15\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_15\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_15\" );        let postRenderFired = false;        function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            gform.core.triggerPostRenderEvents( 15, current_page );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) func.apply( context, args );                };                var callNow = immediate && !timeout;                clearTimeout( timeout );                timeout = setTimeout( later, wait );                if ( callNow ) func.apply( context, args );            };        }        const debouncedTriggerPostRender = debounce( function() {            triggerPostRender();        }, 200 );        if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) {            const observer = new MutationObserver( ( mutations ) => {                mutations.forEach( ( mutation ) => {                    if ( mutation.type === 'attributes' && visibilityTestDiv.offsetParent !== null ) {                        debouncedTriggerPostRender();                        observer.disconnect();                    }                });            });            observer.observe( document.body, {                attributes: true,                childList: false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} );\n<\/script>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":11,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-6799","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/vetaffairs.la.gov\/vi\/wp-json\/wp\/v2\/pages\/6799","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vetaffairs.la.gov\/vi\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/vetaffairs.la.gov\/vi\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/vetaffairs.la.gov\/vi\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/vetaffairs.la.gov\/vi\/wp-json\/wp\/v2\/comments?post=6799"}],"version-history":[{"count":0,"href":"https:\/\/vetaffairs.la.gov\/vi\/wp-json\/wp\/v2\/pages\/6799\/revisions"}],"wp:attachment":[{"href":"https:\/\/vetaffairs.la.gov\/vi\/wp-json\/wp\/v2\/media?parent=6799"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}