{"id":81,"date":"2022-12-30T05:01:27","date_gmt":"2022-12-30T05:01:27","guid":{"rendered":"https:\/\/acehealth.co.id\/?page_id=81"},"modified":"2023-10-03T04:20:17","modified_gmt":"2023-10-03T04:20:17","slug":"partnership-form","status":"publish","type":"page","link":"https:\/\/acehealth.co.id\/?page_id=81","title":{"rendered":"Partnership Form"},"content":{"rendered":"[vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; column_element_spacing=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text]<strong><span style=\"font-size: 35px;\">Form Pengajuan Kemitraan<\/span><br \/>\nHarap mengisi informasi dibawah ini untuk pengajuan bergabung dengan ekosistem kemitraan.<br \/>\n<\/strong>[\/vc_column_text][\/vc_column][\/vc_row]<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-78\"><form id=\"wpforms-form-78\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"78\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F81\" data-token=\"af32f4e28740917461474e10d46531c1\" data-token-time=\"1775712009\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-78-field_2-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"2\"><label class=\"wpforms-field-label\">Nama Anda <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-78-field_2\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][2][first]\" required><label for=\"wpforms-78-field_2\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-78-field_2-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][2][last]\" required><label for=\"wpforms-78-field_2-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-78-field_8-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-78-field_8\">Nomor Telepon <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-78-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" step=\"any\" required><\/div><div id=\"wpforms-78-field_3-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"3\"><label class=\"wpforms-field-label\">Alamat Email Perusahaan <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"email\" id=\"wpforms-78-field_3\" class=\"wpforms-field-required wpforms-field-email-primary\" name=\"wpforms[fields][3][primary]\" spellcheck=\"false\" required><label for=\"wpforms-78-field_3\" class=\"wpforms-field-sublabel after\">Email<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"email\" id=\"wpforms-78-field_3-secondary\" class=\"wpforms-field-email-secondary wpforms-field-required\" data-rule-confirm=\"#wpforms-78-field_3\" name=\"wpforms[fields][3][secondary]\" spellcheck=\"false\" required><label for=\"wpforms-78-field_3-secondary\" class=\"wpforms-field-sublabel after\">Confirm Email<\/label><\/div><\/div><\/div><div id=\"wpforms-78-field_11-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-modern\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-78-field_11\">Jabatan \/ Posisi <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-78-field_11\" class=\"wpforms-field-medium wpforms-field-required choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-medium\" data-search-enabled=\"1\" name=\"wpforms[fields][11]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'><\/option><option value=\"CEO \/ Director \/ Owner\" >CEO \/ Director \/ Owner<\/option><option value=\"Chief of Financial Officer \/ Finance Director\" >Chief of Financial Officer \/ Finance Director<\/option><option value=\"Chief of Technology \/ IT Director\" >Chief of Technology \/ IT Director<\/option><option value=\"Operation Manager\" >Operation Manager<\/option><option value=\"Business Manager \/ Business Development Manager\" >Business Manager \/ Business Development Manager<\/option><option value=\"Marketing Manager\" >Marketing Manager<\/option><option value=\"Partnership Manager\" >Partnership Manager<\/option><option value=\"Sales \/ Account Officer\" >Sales \/ Account Officer<\/option><option value=\"Others\" >Others<\/option><\/select><\/div><div id=\"wpforms-78-field_12-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-modern\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-78-field_12\">Tipe Perusahaan Anda <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-78-field_12\" class=\"wpforms-field-medium wpforms-field-required choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-medium\" data-search-enabled=\"\" name=\"wpforms[fields][12]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'><\/option><option value=\"System Integrator\" >System Integrator<\/option><option value=\"Start-up\" >Start-up<\/option><option value=\"Hospital\" >Hospital<\/option><option value=\"Clinic\" >Clinic<\/option><option value=\"Venture Capital \/ Funding\" >Venture Capital \/ Funding<\/option><option value=\"Others\" >Others<\/option><\/select><\/div><div id=\"wpforms-78-field_4-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-78-field_4\">Nama Perusahaan \/ Entitas <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-78-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" required><\/div><div id=\"wpforms-78-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-78-field_5\">Alamat Perusahaan \/ Entitas <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-78-field_5\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][5]\" required><\/div><div id=\"wpforms-78-field_6-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-3-columns\" data-field-id=\"6\"><label class=\"wpforms-field-label\">Layanan Perusahaan Anda (Anda dapat memilih lebih dari satu) <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-78-field_6\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-78-field_6_1\" name=\"wpforms[fields][6][]\" value=\"Hospital Information System\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-78-field_6_1\">Hospital Information System<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-78-field_6_2\" name=\"wpforms[fields][6][]\" value=\"Electronic Medical Record System (EMR)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-78-field_6_2\">Electronic Medical Record System (EMR)<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-78-field_6_3\" name=\"wpforms[fields][6][]\" value=\"Finance &amp; Accounting System\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-78-field_6_3\">Finance &amp; Accounting System<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-78-field_6_4\" name=\"wpforms[fields][6][]\" value=\"Smart Inventory System\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-78-field_6_4\">Smart Inventory System<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-78-field_6_5\" name=\"wpforms[fields][6][]\" value=\"Smart Appointment System\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-78-field_6_5\">Smart Appointment System<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-78-field_6_10\" name=\"wpforms[fields][6][]\" value=\"Medical App (Aggregator) Platform\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-78-field_6_10\">Medical App (Aggregator) Platform<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-78-field_6_7\" name=\"wpforms[fields][6][]\" value=\"Custom App Builder Services\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-78-field_6_7\">Custom App Builder Services<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-78-field_6_6\" name=\"wpforms[fields][6][]\" value=\"System Integration Services\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-78-field_6_6\">System Integration Services<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-78-field_6_9\" name=\"wpforms[fields][6][]\" value=\"Human Resources Provider Services\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-78-field_6_9\">Human Resources Provider Services<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-78-field_6_11\" name=\"wpforms[fields][6][]\" value=\"Financial Services\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-78-field_6_11\">Financial Services<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-78-field_6_8\" name=\"wpforms[fields][6][]\" value=\"Others*\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-78-field_6_8\">Others*<\/label><\/li><\/ul><div class=\"wpforms-field-description\">Catatan : untuk yang lainnya dapat di tuliskan di message box<\/div><\/div><div id=\"wpforms-78-field_7-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-modern\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-78-field_7\">Jumlah Karyawan <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-78-field_7\" class=\"wpforms-field-medium wpforms-field-required choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-medium\" data-search-enabled=\"\" name=\"wpforms[fields][7]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'><\/option><option value=\"Less than 15 employee\" >Less than 15 employee<\/option><option value=\"16 to 50 employee\" >16 to 50 employee<\/option><option value=\"more than 50 employee\" >more than 50 employee<\/option><\/select><\/div><div id=\"wpforms-78-field_9-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-78-field_9\">Message Box <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-78-field_9\" class=\"wpforms-field-medium wpforms-field-required wpforms-limit-characters-enabled\" data-form-id=\"78\" data-field-id=\"9\" data-text-limit=\"500\" name=\"wpforms[fields][9]\" maxlength=\"500\" required><\/textarea><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"78\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/acehealth.co.id\/index.php?rest_route=\/wp\/v2\/pages\/81\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-78\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/acehealth.co.id\/wp-content\/plugins\/wpforms-lite2\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n","protected":false},"excerpt":{"rendered":"<p>[vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; column_element_spacing=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221;&#8230;<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":["post-81","page","type-page","status-publish"],"_links":{"self":[{"href":"https:\/\/acehealth.co.id\/index.php?rest_route=\/wp\/v2\/pages\/81","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/acehealth.co.id\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/acehealth.co.id\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/acehealth.co.id\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/acehealth.co.id\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=81"}],"version-history":[{"count":4,"href":"https:\/\/acehealth.co.id\/index.php?rest_route=\/wp\/v2\/pages\/81\/revisions"}],"predecessor-version":[{"id":341,"href":"https:\/\/acehealth.co.id\/index.php?rest_route=\/wp\/v2\/pages\/81\/revisions\/341"}],"wp:attachment":[{"href":"https:\/\/acehealth.co.id\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=81"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}