{"_id":"676d612711b45b1f218b7023","title":"VA_VISN2_v2","name":"vaVisn2V2","path":"vavisn2v2","type":"form","display":"form","tags":[],"access":[{"type":"read_all","roles":["5f9ae327f1b65926a66350f3","5f9ae327f1b65921a76350f4"]},{"type":"update_all","roles":["5f9ae327f1b65926a66350f3"]}],"submissionAccess":[{"type":"create_all","roles":["5f9ae327f1b65926a66350f3","5f9ae327f1b65921a76350f4"]}],"owner":"5f9acba5f1b659b9e06350e4","components":[{"label":"Top of Form","columns":[{"components":[{"label":"<font color=\"red\">authorizationToken</font>","key":"authorizationToken","type":"hidden","input":true,"tableView":false,"hideOnChildrenHidden":true,"width":12}],"width":2,"offset":0,"push":0,"pull":0,"size":"md","currentWidth":2},{"components":[{"label":"<font color=\"green\">agencyFormId</font>","key":"agencyFormId","type":"hidden","input":true,"tableView":false,"hideOnChildrenHidden":true,"width":12}],"width":2,"offset":0,"push":0,"pull":0,"size":"md","currentWidth":2},{"components":[{"label":"min/max","persistent":"client-only","calculateServer":true,"trigger":{"init":true,"server":true},"dataSrc":"url","fetch":{"url":"{{ config.PAYGOV_ENV }}/public/api/v1/minmaxamount/{{ data.agencyFormId }}","method":"get","headers":[{"key":"X-Paygov-Authorization-Token","value":"{{ data.authorizationToken }}"}],"forwardHeaders":true,"authenticate":false},"key":"minMax","type":"datasource","input":true,"tableView":false,"hideOnChildrenHidden":true,"width":12}],"width":2,"offset":0,"push":0,"pull":0,"size":"md","currentWidth":2},{"components":[{"label":"Company Profile","persistent":"client-only","calculateServer":true,"trigger":{"init":true,"server":true},"dataSrc":"url","fetch":{"url":"{{ config.PAYGOV_ENV }}/public/api/v1/companyprofile/{{ data.agencyFormId }}","method":"get","headers":[{"key":"X-Paygov-Authorization-Token","value":"{{ data.authorizationToken }}"}],"forwardHeaders":true,"authenticate":false},"key":"CompanyDataFromPaygov","type":"datasource","input":true,"tableView":false,"validate":{"multiple":true},"hideOnChildrenHidden":true,"keyModified":true,"multiple":true,"width":12}],"width":2,"offset":0,"push":0,"pull":0,"size":"md","currentWidth":2}],"autoAdjust":true,"hideOnChildrenHidden":true,"key":"columns3","type":"columns","input":false,"tableView":false,"lockKey":true,"source":"5eac84259b53ff041c170ee7","isNew":true},{"label":"HTML","tag":"h3","attrs":[{"attr":"","value":""}],"content":"NY/NJ VA Health Care Network<br>\n&nbsp;","refreshOnChange":false,"key":"html","type":"htmlelement","input":false,"tableView":false},{"label":"HTML","attrs":[{"attr":"","value":""}],"content":"Welcome to the Department of Veterans Affairs, NY/NJ VA Health Care Network donation page. Please select the facility to which you would like to donate.<br><br>\n\n<font color=\"red\">*</font> Required Field<br>&nbsp;","refreshOnChange":false,"key":"html2","type":"htmlelement","input":false,"tableView":false,"hideOnChildrenHidden":false},{"label":"Columns","columns":[{"components":[{"label":"Facility","widget":"html5","tableView":true,"dataSrc":"custom","data":{"custom":"values = [\r\n    {\r\n        \"label\" : \"James J. Peters VA Medical Center \",\r\n        \"locationCode\" : \"526\",\r\n        \"title\" : \"James J. Peters VA Medical Center \",\r\n        \"name\" : \"James J. 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\"locationCode\" : \"528\",\r\n        \"value\" : \"1857\",\r\n        \"label\" : \"Outpatient Clinic Transport\"\r\n    },\r\n    {\r\n        \"locationCode\" : \"528\",\r\n        \"value\" : \"1860\",\r\n        \"label\" : \"Nursing Health Care Unit - WARD 9A\"\r\n    },\r\n    {\r\n        \"locationCode\" : \"528\",\r\n        \"value\" : \"1931\",\r\n        \"label\" : \"Women's Wellness Center\"\r\n    },\r\n    {\r\n        \"locationCode\" : \"528\",\r\n        \"value\" : \"1937\",\r\n        \"label\" : \"No One Dies Alone\"\r\n    },\r\n    {\r\n        \"locationCode\" : \"528\",\r\n        \"value\" : \"1939\",\r\n        \"label\" : \"Transition Care and Management Program\"\r\n    },\r\n    {\r\n        \"locationCode\" : \"528\",\r\n        \"value\" : \"1940\",\r\n        \"label\" : \"Vocational Program\"\r\n    },\r\n    {\r\n        \"locationCode\" : \"528\",\r\n        \"value\" : \"1942\",\r\n        \"label\" : \"Visually Impaired\"\r\n    },\r\n    {\r\n  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\"locationCode\" : \"528A4\",\r\n        \"value\" : \"1933\",\r\n        \"label\" : \"Women Veterans Center for Hope - Batavia\"\r\n    },\r\n    {\r\n        \"locationCode\" : \"528A4\",\r\n        \"value\" : \"1935\",\r\n        \"label\" : \"Men's Residential Treatment Program\"\r\n    },\r\n    {\r\n        \"locationCode\" : \"528A5\",\r\n        \"value\" : \"1406\",\r\n        \"label\" : \"VA Food Pantry\"\r\n    },\r\n    {\r\n        \"locationCode\" : \"528A5\",\r\n        \"value\" : \"1613\",\r\n        \"label\" : \"Recreation\"\r\n    },\r\n    {\r\n        \"locationCode\" : \"528A5\",\r\n        \"value\" : \"1640\",\r\n        \"label\" : \"Palliative Care/Hospice\"\r\n    },\r\n    {\r\n        \"locationCode\" : \"528A5\",\r\n        \"value\" : \"1641\",\r\n        \"label\" : \"Women Veterans\"\r\n    },\r\n    {\r\n        \"locationCode\" : \"528A5\",\r\n        \"value\" : \"1609\",\r\n        \"label\" : \"Homeless Veterans\"\r\n    },\r\n    {\r\n        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