{"id":4275,"date":"2021-04-06T13:04:01","date_gmt":"2021-04-06T17:04:01","guid":{"rendered":"https:\/\/brainarcevaluations.com\/?page_id=4275"},"modified":"2021-06-29T20:26:12","modified_gmt":"2021-06-30T00:26:12","slug":"referral-for-neurological-consult","status":"publish","type":"page","link":"https:\/\/brainarcevaluations.com\/referral-for-neurological-consult\/","title":{"rendered":"Referral for Neurological Consult"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.9.3&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;5%||1%||false|false&#8221;][et_pb_row _builder_version=&#8221;4.9.3&#8243; _module_preset=&#8221;default&#8221; custom_margin=&#8221;||||false|false&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.9.3&#8243; _module_preset=&#8221;default&#8221;][et_pb_text _builder_version=&#8221;4.9.3&#8243; _module_preset=&#8221;default&#8221; hover_enabled=&#8221;0&#8243; sticky_enabled=&#8221;0&#8243;]<\/p>\n<h1>Referral for Review of EEG by Neurologist<\/h1>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.9.3&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;5%||5%||true|false&#8221;][et_pb_row _builder_version=&#8221;4.9.3&#8243; _module_preset=&#8221;default&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.9.3&#8243; _module_preset=&#8221;default&#8221;][et_pb_code module_id=&#8221;register-form&#8221; _builder_version=&#8221;4.9.3&#8243; _module_preset=&#8221;default&#8221;]<div class=\"forminator-ui forminator-custom-form forminator-custom-form-4274 forminator-design--flat  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-4274\" data-uid=\"663a165e4f782\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-4274\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-4274 forminator-design--flat  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"4274\"\n\t\t\t\t\n\t\t\t\tdata-design=\"flat\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tdata-grid=\"open\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tstyle=\"display: none;\"\n\t\t\t\t\n\t\t\t\tdata-uid=\"663a165e4f782\"\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_663a165e4f782\" id=\"forminator-field-name-1_663a165e4f782-label\" class=\"forminator-label\">Referring clinician <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"E.g., John Doe, MD\" id=\"forminator-field-name-1_663a165e4f782\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_663a165e4f782\" id=\"forminator-field-name-2_663a165e4f782-label\" class=\"forminator-label\">Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"E.g., Steve Smith\" id=\"forminator-field-name-2_663a165e4f782\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_663a165e4f782\" id=\"forminator-field-email-1_663a165e4f782-label\" class=\"forminator-label\">Email <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"E.g., john@doe.com\" id=\"forminator-field-email-1_663a165e4f782\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_663a165e4f782\" id=\"forminator-field-phone-1_663a165e4f782-label\" class=\"forminator-label\">Phone Number <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"E.g., +1 300 400 5000\" id=\"forminator-field-phone-1_663a165e4f782\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-1\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">General information<\/h2><h3 class=\"forminator-subtitle\">Required<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-3\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-3_663a165e4f782\" id=\"forminator-field-name-3_663a165e4f782-label\" class=\"forminator-label\">Name(last name, first name) or code <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-3\" value=\"\" placeholder=\"E.g., John Doe\" id=\"forminator-field-name-3_663a165e4f782\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_663a165e4f782\" id=\"forminator-field-date-1-picker_663a165e4f782-label\" class=\"forminator-label\">Date of birth <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-1-picker_663a165e4f782\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"Date of birth\" id=\"forminator-field-date-1-picker_663a165e4f782\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd-mm-yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1924\" data-end-year=\"2124\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/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-663a165e4f782-label\" aria-describedby=\"forminator-radiogroup-663a165e4f782-description\"><span id=\"forminator-radiogroup-663a165e4f782-label\" class=\"forminator-label\">Gender <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-663a165e4f782\" class=\"forminator-radio\" title=\"Male\"><input type=\"radio\" name=\"radio-1\" value=\"male\" id=\"forminator-field-radio-1-1-663a165e4f782\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-1-663a165e4f782-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Male<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-663a165e4f782\" class=\"forminator-radio\" title=\"Female\"><input type=\"radio\" name=\"radio-1\" value=\"female\" id=\"forminator-field-radio-1-2-663a165e4f782\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-1-663a165e4f782-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Female<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-2\" class=\"forminator-field-date forminator-col forminator-col-12 \"><label for=\"forminator-field-date-2\" id=\"forminator-field-date-2-label\" class=\"forminator-label\">Date of study <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-date-input\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-2-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-month_663a165e4f782\" class=\"forminator-label\">Month <span class=\"forminator-required\">*<\/span><\/label><input type=\"number\" min=\"1\" max=\"12\" name=\"date-2-month\" value=\"\" placeholder=\"E.g. 01\" id=\"forminator-field-date-2-month_663a165e4f782\" class=\"forminator-input\" data-field=\"month\" data-format=\"mm\/dd\/yy\" data-parent=\"date-2\" aria-describedby=\"forminator-field-date-2_663a165e4f782-description\" \/><\/div><\/div><div id=\"date-2-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-day_663a165e4f782\" class=\"forminator-label\">Day <span class=\"forminator-required\">*<\/span><\/label><input type=\"number\" min=\"1\" max=\"31\" name=\"date-2-day\" value=\"\" placeholder=\"E.g. 01\" id=\"forminator-field-date-2-day_663a165e4f782\" class=\"forminator-input\" data-field=\"day\" data-format=\"mm\/dd\/yy\" data-parent=\"date-2\" aria-describedby=\"forminator-field-date-2_663a165e4f782-description\" \/><\/div><\/div><div id=\"date-2-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-year_663a165e4f782\" class=\"forminator-label\">Year <span class=\"forminator-required\">*<\/span><\/label><input type=\"number\" min=\"1\" name=\"date-2-year\" placeholder=\"E.g. 2000\" id=\"forminator-field-date-2-year_663a165e4f782\" class=\"forminator-input\" data-field=\"year\" value=\"\" data-format=\"mm\/dd\/yy\" data-parent=\"date-2\" aria-describedby=\"forminator-field-date-2_663a165e4f782-description\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-663a165e4f782-label\" aria-describedby=\"forminator-radiogroup-663a165e4f782-description\"><span id=\"forminator-radiogroup-663a165e4f782-label\" class=\"forminator-label\">Handed <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-663a165e4f782\" class=\"forminator-radio\" title=\"Right\"><input type=\"radio\" name=\"radio-2\" value=\"right\" id=\"forminator-field-radio-2-1-663a165e4f782\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-2-663a165e4f782-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Right<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-663a165e4f782\" class=\"forminator-radio\" title=\"Left\"><input type=\"radio\" name=\"radio-2\" value=\"left\" id=\"forminator-field-radio-2-2-663a165e4f782\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-2-663a165e4f782-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Left<\/span><\/label><label id=\"forminator-field-radio-2-label-3\" for=\"forminator-field-radio-2-3-663a165e4f782\" class=\"forminator-radio\" title=\"Ambidextrous\"><input type=\"radio\" name=\"radio-2\" value=\"ambidextrous\" id=\"forminator-field-radio-2-3-663a165e4f782\" aria-labelledby=\"forminator-field-radio-2-label-3\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-2-663a165e4f782-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Ambidextrous<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_663a165e4f782\" id=\"forminator-field-textarea-1_663a165e4f782-label\" class=\"forminator-label\">Psychiatric\/ Medical Diagnoses <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_663a165e4f782\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/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_663a165e4f782\" id=\"forminator-field-textarea-2_663a165e4f782-label\" class=\"forminator-label\">Reason for assessment <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_663a165e4f782\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/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_663a165e4f782\" id=\"forminator-field-textarea-3_663a165e4f782-label\" class=\"forminator-label\">Medication taken now <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_663a165e4f782\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-2\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Clinical history<\/h2><h3 class=\"forminator-subtitle\">If relevant, please give brief description of:<\/h3><\/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_663a165e4f782\" id=\"forminator-field-textarea-4_663a165e4f782-label\" class=\"forminator-label\">Birth trauma and\/or hypoxia<\/label><textarea name=\"textarea-4\" placeholder=\"\" id=\"forminator-field-textarea-4_663a165e4f782\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-5\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-5_663a165e4f782\" id=\"forminator-field-textarea-5_663a165e4f782-label\" class=\"forminator-label\">Head trauma (with or without loss of consciousness)<\/label><textarea name=\"textarea-5\" placeholder=\"\" id=\"forminator-field-textarea-5_663a165e4f782\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-6\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-6_663a165e4f782\" id=\"forminator-field-textarea-6_663a165e4f782-label\" class=\"forminator-label\">History of Seizures (Self or biological realtives)<\/label><textarea name=\"textarea-6\" placeholder=\"\" id=\"forminator-field-textarea-6_663a165e4f782\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-7\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-7_663a165e4f782\" id=\"forminator-field-textarea-7_663a165e4f782-label\" class=\"forminator-label\">Sleep related difficulties<\/label><textarea name=\"textarea-7\" placeholder=\"\" id=\"forminator-field-textarea-7_663a165e4f782\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-8\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-8_663a165e4f782\" id=\"forminator-field-textarea-8_663a165e4f782-label\" class=\"forminator-label\">Alcohol\/ Drug Abuse<\/label><textarea name=\"textarea-8\" placeholder=\"\" id=\"forminator-field-textarea-8_663a165e4f782\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-9\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-9_663a165e4f782\" id=\"forminator-field-textarea-9_663a165e4f782-label\" class=\"forminator-label\">Attention Issues<\/label><textarea name=\"textarea-9\" placeholder=\"\" id=\"forminator-field-textarea-9_663a165e4f782\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-10\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-10_663a165e4f782\" id=\"forminator-field-textarea-10_663a165e4f782-label\" class=\"forminator-label\">Affective Regulation Issues<\/label><textarea name=\"textarea-10\" placeholder=\"\" id=\"forminator-field-textarea-10_663a165e4f782\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-11\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-11_663a165e4f782\" id=\"forminator-field-textarea-11_663a165e4f782-label\" class=\"forminator-label\">Memory Issues<\/label><textarea name=\"textarea-11\" placeholder=\"\" id=\"forminator-field-textarea-11_663a165e4f782\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-12\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-12_663a165e4f782\" id=\"forminator-field-textarea-12_663a165e4f782-label\" class=\"forminator-label\">Other - please add a brief description of any other relevant clinical information<\/label><textarea name=\"textarea-12\" placeholder=\"\" id=\"forminator-field-textarea-12_663a165e4f782\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"calculation-1\" class=\"forminator-field-calculation forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"calculation-1-field_663a165e4f782\" id=\"calculation-1-field_663a165e4f782-label\" class=\"forminator-label\">Price<\/label><input name=\"calculation-1\" value=\"\" id=\"calculation-1-field_663a165e4f782\" class=\"forminator-calculation forminator-input\" data-formula=\"230*1\" data-required=\"\" data-decimal-point=\".\" data-precision=\"2\" data-is-hidden=\"\" disabled=\"disabled\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" \/><\/div><\/div><\/div><div class=\"forminator-row forminator-hidden\"><div id=\"paypal-1\" class=\"forminator-field-paypal forminator-col forminator-col-12 \"><input type=\"hidden\" name=\"paypal-1\" id=\"forminator-paypal-1-field_663a165e4f782\" class=\"forminator-paypal-input\" data-is-payment=\"true\" data-payment-type=\"paypal\" data-currency=\"usd\" data-amount-type=\"variable\" data-amount=\"calculation-1\" data-label=\"\" data-locale=\"en\" value=\"\" \/><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><input type=\"hidden\" name=\"payment_gateway_total\" value=\"\" \/><div class=\"forminator-row forminator-paypal-row\"><div class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><div id=\"paypal-button-container-4274_663a165e4f782\" class=\"paypal-1-payment forminator-button-paypal\"><\/div><\/div><\/div><\/div><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Finish<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"2eb6d6508c\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/4275\" \/><input type=\"hidden\" name=\"form_id\" value=\"4274\"><input type=\"hidden\" name=\"page_id\" value=\"4275\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/brainarcevaluations.com\/referral-for-neurological-consult\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><label for=\"input_24\" class=\"forminator-hidden\" aria-hidden=\"true\">Please do not fill in this field. <input id=\"input_24\" type=\"text\" name=\"input_24\" value=\"\" autocomplete=\"off\"><\/label><\/form>[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Referral for Review of EEG by Neurologist<div class=\"forminator-ui forminator-custom-form forminator-custom-form-4274 forminator-design--flat  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-4274\" data-uid=\"663a165e946d0\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-4274\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-4274 forminator-design--flat  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"4274\"\n\t\t\t\t\n\t\t\t\tdata-design=\"flat\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tdata-grid=\"open\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tstyle=\"display: none;\"\n\t\t\t\t\n\t\t\t\tdata-uid=\"663a165e946d0\"\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_663a165e946d0\" id=\"forminator-field-name-1_663a165e946d0-label\" class=\"forminator-label\">Referring clinician <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"E.g., John Doe, MD\" id=\"forminator-field-name-1_663a165e946d0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_663a165e946d0\" id=\"forminator-field-name-2_663a165e946d0-label\" class=\"forminator-label\">Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"E.g., Steve Smith\" id=\"forminator-field-name-2_663a165e946d0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_663a165e946d0\" id=\"forminator-field-email-1_663a165e946d0-label\" class=\"forminator-label\">Email <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"E.g., john@doe.com\" id=\"forminator-field-email-1_663a165e946d0\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_663a165e946d0\" id=\"forminator-field-phone-1_663a165e946d0-label\" class=\"forminator-label\">Phone Number <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"E.g., +1 300 400 5000\" id=\"forminator-field-phone-1_663a165e946d0\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-1\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">General information<\/h2><h3 class=\"forminator-subtitle\">Required<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-3\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-3_663a165e946d0\" id=\"forminator-field-name-3_663a165e946d0-label\" class=\"forminator-label\">Name(last name, first name) or code <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-3\" value=\"\" placeholder=\"E.g., John Doe\" id=\"forminator-field-name-3_663a165e946d0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_663a165e946d0\" id=\"forminator-field-date-1-picker_663a165e946d0-label\" class=\"forminator-label\">Date of birth <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-1-picker_663a165e946d0\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"Date of birth\" id=\"forminator-field-date-1-picker_663a165e946d0\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd-mm-yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1924\" data-end-year=\"2124\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/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-663a165e946d0-label\" aria-describedby=\"forminator-radiogroup-663a165e946d0-description\"><span id=\"forminator-radiogroup-663a165e946d0-label\" class=\"forminator-label\">Gender <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-663a165e946d0\" class=\"forminator-radio\" title=\"Male\"><input type=\"radio\" name=\"radio-1\" value=\"male\" id=\"forminator-field-radio-1-1-663a165e946d0\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-1-663a165e946d0-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Male<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-663a165e946d0\" class=\"forminator-radio\" title=\"Female\"><input type=\"radio\" name=\"radio-1\" value=\"female\" id=\"forminator-field-radio-1-2-663a165e946d0\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-1-663a165e946d0-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Female<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-2\" class=\"forminator-field-date forminator-col forminator-col-12 \"><label for=\"forminator-field-date-2\" id=\"forminator-field-date-2-label\" class=\"forminator-label\">Date of study <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-date-input\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-2-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-month_663a165e946d0\" class=\"forminator-label\">Month <span class=\"forminator-required\">*<\/span><\/label><input type=\"number\" min=\"1\" max=\"12\" name=\"date-2-month\" value=\"\" placeholder=\"E.g. 01\" id=\"forminator-field-date-2-month_663a165e946d0\" class=\"forminator-input\" data-field=\"month\" data-format=\"mm\/dd\/yy\" data-parent=\"date-2\" aria-describedby=\"forminator-field-date-2_663a165e946d0-description\" \/><\/div><\/div><div id=\"date-2-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-day_663a165e946d0\" class=\"forminator-label\">Day <span class=\"forminator-required\">*<\/span><\/label><input type=\"number\" min=\"1\" max=\"31\" name=\"date-2-day\" value=\"\" placeholder=\"E.g. 01\" id=\"forminator-field-date-2-day_663a165e946d0\" class=\"forminator-input\" data-field=\"day\" data-format=\"mm\/dd\/yy\" data-parent=\"date-2\" aria-describedby=\"forminator-field-date-2_663a165e946d0-description\" \/><\/div><\/div><div id=\"date-2-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-year_663a165e946d0\" class=\"forminator-label\">Year <span class=\"forminator-required\">*<\/span><\/label><input type=\"number\" min=\"1\" name=\"date-2-year\" placeholder=\"E.g. 2000\" id=\"forminator-field-date-2-year_663a165e946d0\" class=\"forminator-input\" data-field=\"year\" value=\"\" data-format=\"mm\/dd\/yy\" data-parent=\"date-2\" aria-describedby=\"forminator-field-date-2_663a165e946d0-description\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-663a165e946d0-label\" aria-describedby=\"forminator-radiogroup-663a165e946d0-description\"><span id=\"forminator-radiogroup-663a165e946d0-label\" class=\"forminator-label\">Handed <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-663a165e946d0\" class=\"forminator-radio\" title=\"Right\"><input type=\"radio\" name=\"radio-2\" value=\"right\" id=\"forminator-field-radio-2-1-663a165e946d0\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-2-663a165e946d0-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Right<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-663a165e946d0\" class=\"forminator-radio\" title=\"Left\"><input type=\"radio\" name=\"radio-2\" value=\"left\" id=\"forminator-field-radio-2-2-663a165e946d0\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-2-663a165e946d0-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Left<\/span><\/label><label id=\"forminator-field-radio-2-label-3\" for=\"forminator-field-radio-2-3-663a165e946d0\" class=\"forminator-radio\" title=\"Ambidextrous\"><input type=\"radio\" name=\"radio-2\" value=\"ambidextrous\" id=\"forminator-field-radio-2-3-663a165e946d0\" aria-labelledby=\"forminator-field-radio-2-label-3\" data-calculation=\"0\"   aria-describedby=\"forminator-field-radio-2-663a165e946d0-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Ambidextrous<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_663a165e946d0\" id=\"forminator-field-textarea-1_663a165e946d0-label\" class=\"forminator-label\">Psychiatric\/ Medical Diagnoses <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_663a165e946d0\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/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_663a165e946d0\" id=\"forminator-field-textarea-2_663a165e946d0-label\" class=\"forminator-label\">Reason for assessment <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_663a165e946d0\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/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_663a165e946d0\" id=\"forminator-field-textarea-3_663a165e946d0-label\" class=\"forminator-label\">Medication taken now <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_663a165e946d0\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-2\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Clinical history<\/h2><h3 class=\"forminator-subtitle\">If relevant, please give brief description of:<\/h3><\/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_663a165e946d0\" id=\"forminator-field-textarea-4_663a165e946d0-label\" class=\"forminator-label\">Birth trauma and\/or hypoxia<\/label><textarea name=\"textarea-4\" placeholder=\"\" id=\"forminator-field-textarea-4_663a165e946d0\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-5\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-5_663a165e946d0\" id=\"forminator-field-textarea-5_663a165e946d0-label\" class=\"forminator-label\">Head trauma (with or without loss of consciousness)<\/label><textarea name=\"textarea-5\" placeholder=\"\" id=\"forminator-field-textarea-5_663a165e946d0\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-6\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-6_663a165e946d0\" id=\"forminator-field-textarea-6_663a165e946d0-label\" class=\"forminator-label\">History of Seizures (Self or biological realtives)<\/label><textarea name=\"textarea-6\" placeholder=\"\" id=\"forminator-field-textarea-6_663a165e946d0\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-7\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-7_663a165e946d0\" id=\"forminator-field-textarea-7_663a165e946d0-label\" class=\"forminator-label\">Sleep related difficulties<\/label><textarea name=\"textarea-7\" placeholder=\"\" id=\"forminator-field-textarea-7_663a165e946d0\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-8\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-8_663a165e946d0\" id=\"forminator-field-textarea-8_663a165e946d0-label\" class=\"forminator-label\">Alcohol\/ Drug Abuse<\/label><textarea name=\"textarea-8\" placeholder=\"\" id=\"forminator-field-textarea-8_663a165e946d0\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-9\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-9_663a165e946d0\" id=\"forminator-field-textarea-9_663a165e946d0-label\" class=\"forminator-label\">Attention Issues<\/label><textarea name=\"textarea-9\" placeholder=\"\" id=\"forminator-field-textarea-9_663a165e946d0\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-10\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-10_663a165e946d0\" id=\"forminator-field-textarea-10_663a165e946d0-label\" class=\"forminator-label\">Affective Regulation Issues<\/label><textarea name=\"textarea-10\" placeholder=\"\" id=\"forminator-field-textarea-10_663a165e946d0\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-11\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-11_663a165e946d0\" id=\"forminator-field-textarea-11_663a165e946d0-label\" class=\"forminator-label\">Memory Issues<\/label><textarea name=\"textarea-11\" placeholder=\"\" id=\"forminator-field-textarea-11_663a165e946d0\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-12\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-12_663a165e946d0\" id=\"forminator-field-textarea-12_663a165e946d0-label\" class=\"forminator-label\">Other - please add a brief description of any other relevant clinical information<\/label><textarea name=\"textarea-12\" placeholder=\"\" id=\"forminator-field-textarea-12_663a165e946d0\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"calculation-1\" class=\"forminator-field-calculation forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"calculation-1-field_663a165e946d0\" id=\"calculation-1-field_663a165e946d0-label\" class=\"forminator-label\">Price<\/label><input name=\"calculation-1\" value=\"\" id=\"calculation-1-field_663a165e946d0\" class=\"forminator-calculation forminator-input\" data-formula=\"230*1\" data-required=\"\" data-decimal-point=\".\" data-precision=\"2\" data-is-hidden=\"\" disabled=\"disabled\" data-decimals=\"2\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;.&#039;, &#039;digits&#039;: &#039;2&#039;\" \/><\/div><\/div><\/div><div class=\"forminator-row forminator-hidden\"><div id=\"paypal-1\" class=\"forminator-field-paypal forminator-col forminator-col-12 \"><input type=\"hidden\" name=\"paypal-1\" id=\"forminator-paypal-1-field_663a165e946d0\" class=\"forminator-paypal-input\" data-is-payment=\"true\" data-payment-type=\"paypal\" data-currency=\"usd\" data-amount-type=\"variable\" data-amount=\"calculation-1\" data-label=\"\" data-locale=\"en\" value=\"\" \/><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><input type=\"hidden\" name=\"payment_gateway_total\" value=\"\" \/><div class=\"forminator-row forminator-paypal-row\"><div class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><div id=\"paypal-button-container-4274_663a165e946d0\" class=\"paypal-1-payment forminator-button-paypal\"><\/div><\/div><\/div><\/div><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Finish<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"2eb6d6508c\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/4275\" \/><input type=\"hidden\" name=\"form_id\" value=\"4274\"><input type=\"hidden\" name=\"page_id\" value=\"4275\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/brainarcevaluations.com\/referral-for-neurological-consult\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><label for=\"input_24\" class=\"forminator-hidden\" aria-hidden=\"true\">Please do not fill in this field. <input id=\"input_24\" type=\"text\" name=\"input_24\" value=\"\" autocomplete=\"off\"><\/label><label for=\"input_24\" class=\"forminator-hidden\" aria-hidden=\"true\">Please do not fill in this field. <input id=\"input_24\" type=\"text\" name=\"input_24\" value=\"\" autocomplete=\"off\"><\/label><\/form><\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"_links":{"self":[{"href":"https:\/\/brainarcevaluations.com\/wp-json\/wp\/v2\/pages\/4275"}],"collection":[{"href":"https:\/\/brainarcevaluations.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brainarcevaluations.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brainarcevaluations.com\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/brainarcevaluations.com\/wp-json\/wp\/v2\/comments?post=4275"}],"version-history":[{"count":5,"href":"https:\/\/brainarcevaluations.com\/wp-json\/wp\/v2\/pages\/4275\/revisions"}],"predecessor-version":[{"id":4336,"href":"https:\/\/brainarcevaluations.com\/wp-json\/wp\/v2\/pages\/4275\/revisions\/4336"}],"wp:attachment":[{"href":"https:\/\/brainarcevaluations.com\/wp-json\/wp\/v2\/media?parent=4275"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}