{"_id":"64382d0f3f91e9ecac655548","type":"form","tags":[],"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=\"red\">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":[],"width":2,"offset":0,"push":0,"pull":0,"size":"md","currentWidth":2}],"autoAdjust":true,"hideOnChildrenHidden":true,"key":"columns1","type":"columns","input":false,"tableView":false,"lockKey":true,"source":"5eac84259b53ff041c170ee7","isNew":true},{"label":"HTML","tag":"img","attrs":[{"attr":"src","value":"{{ config.STATIC_ASSETS_ENV }}/VAVISN/images/visn20_logo.jpg"},{"attr":"alt","value":"VA NORTHWEST HEALTH CARE NETWORK VISN 20"},{"attr":"title","value":"VA NORTHWEST HEALTH CARE NETWORK VISN 20"},{"attr":"style","value":"max-width: 250px;"}],"refreshOnChange":false,"key":"html","type":"htmlelement","input":false,"tableView":false},{"label":"HTML","tag":"h3","attrs":[{"attr":"","value":""}],"content":"VA NORTHWEST HEALTH CARE NETWORK:  VISN 20<br>&nbsp;","refreshOnChange":false,"key":"html1","type":"htmlelement","input":false,"tableView":false},{"label":"HTML","attrs":[{"attr":"","value":""}],"content":"Welcome to the Department of Veterans Affairs Northwest Healthcare Network donation page.  The VA Northwest Healthcare Network Alaska, Boise, Portland, Puget Sound, Roseburg, Spokane, Walla Walla and White City.  Please click on 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},{"label":"Columns","columns":[{"components":[{"label":"Facility","widget":"html5","tableView":true,"dataSrc":"custom","data":{"custom":"values = [\r\n    {\r\n        \"label\" : \"Alaska Veteran Affairs Healthcare System\",\r\n        \"locationCode\" : \"463\",\r\n        \"title\" : \"Alaska Veteran Affairs Healthcare System\",\r\n        \"image\" : \"visn20_alaska.jpg\",\r\n        \"maxWidth\" : \"250\"\r\n    },\r\n    {\r\n        \"label\" : \"Boise VA Medical Center\",\r\n        \"locationCode\" : \"531\",\r\n        \"title\" : \"Boise VA Medical Center\",\r\n        \"image\" : \"visn20_boise.jpg\",\r\n        \"maxWidth\" : \"250\"\r\n    },\r\n    {\r\n        \"label\" : \"VA Portland Health Care System\",\r\n        \"locationCode\" : \"648\",\r\n        \"title\" : \"VA Portland Health Care System\",\r\n        \"image\" : \"visn20_portland.jpg\",\r\n        \"maxWidth\" : \"250\"\r\n    },\r\n    {\r\n        \"label\" : \"Roseburg VA Healthcare System\",\r\n        \"locationCode\" : \"653\",\r\n        \"title\" : \"Roseburg VA Healthcare System\",\r\n        \"image\" : \"visn20_roseburg.jpg\",\r\n        \"maxWidth\" : \"250\"\r\n    },\r\n    {\r\n        \"label\" : \"Mann-Grandstaff VA Medical Center\",\r\n        \"locationCode\" : \"668\",\r\n        \"title\" : \"Mann-Grandstaff VA Medical Center\",\r\n        \"image\" : \"visn20_spokane.jpg\",\r\n        \"maxWidth\" : \"250\"\r\n    },\r\n    {\r\n        \"label\" : \"Jonathan M. 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