www.pintasnursinghomelaw.com
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Submitted URL: http://www.planecoll.com/c/ClcNVX_fThZ_GpB-lfivN_QjFygrhzg3etTo5S2HKKeiotrRkHLkzFui1NKfzyg4lnZN_pONEwwy7x9Tynhuyrrkkh44w2...
Effective URL: https://www.pintasnursinghomelaw.com/?utm_source=mdv&utm_medium=email&utm_campaign=MNH202211&utm_content=162175&utm_term=2463c33ad8c5...
Submission: On March 08 via manual from US — Scanned from DE
Effective URL: https://www.pintasnursinghomelaw.com/?utm_source=mdv&utm_medium=email&utm_campaign=MNH202211&utm_content=162175&utm_term=2463c33ad8c5...
Submission: On March 08 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST /Home/DynamicForm/id?Length=0
<form action="/Home/DynamicForm/id?Length=0" method="post" id="leadForm" class="publishedForm">
<div class="questionRow toggleBlockImportant">
<div class="question-box">
<div class="">
<input data-val="true" data-val-required="The Id field is required." id="AllQuestions_0__Id" name="AllQuestions[0].Id" type="hidden" value="170">
<input data-val="true" data-val-required="The Label field is required." id="AllQuestions_0__Label" name="AllQuestions[0].Label" type="hidden"
value="Has your loved one experienced any of the following in a Nursing Home or Assisted Living Facility?">
<input data-val="true" data-val-required="The DisqualifyingQuestion field is required." id="AllQuestions_0__DisqualifyingQuestion" name="AllQuestions[0].DisqualifyingQuestion" type="hidden" value="True">
<div style="display:flex; margin-right:1.25rem">
<label for="AllQuestions_0__Response" class="questionLabel">Has your loved one experienced any of the following in a Nursing Home or Assisted Living Facility?*</label>
</div>
<select id="AllQuestions_0__Response" name="AllQuestions[0].Response" required="true" class="formDropdown">
<option disabled="disabled" selected="selected" value="">Select</option>
<option value="Bedsores">Bedsores</option>
<option value="Bowel Impaction">Bowel Impaction</option>
<option value="Choking/Death">Choking/Death</option>
<option value="Death due to COVID-19">Death due to COVID-19</option>
<option value="Fall">Fall</option>
<option value="Fractured Bones">Fractured Bones</option>
<option value="Infections">Infections</option>
<option value="Improper Treatment/Medication">Improper Treatment/Medication</option>
<option value="Malnutrition/Dehydration">Malnutrition/Dehydration</option>
<option value="Respiratory Illness">Respiratory Illness</option>
<option value="Sexual Abuse">Sexual Abuse</option>
<option value="Other">Other</option>
<option value="None of the above">None of the above</option>
</select><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_0__Answers_0__Id" name="AllQuestions[0].Answers[0].Id" type="hidden" value="118794"><input data-val="true"
data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" data-val-required="The Label field is required." id="AllQuestions_0__Answers_0__Label"
name="AllQuestions[0].Answers[0].Label" type="hidden" value="Bedsores"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required." id="AllQuestions_0__Answers_0__DisqualifyingAnswer"
name="AllQuestions[0].Answers[0].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_0__Answers_1__Id" name="AllQuestions[0].Answers[1].Id" type="hidden"
value="118795"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" data-val-required="The Label field is required."
id="AllQuestions_0__Answers_1__Label" name="AllQuestions[0].Answers[1].Label" type="hidden" value="Bowel Impaction"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_0__Answers_1__DisqualifyingAnswer" name="AllQuestions[0].Answers[1].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_0__Answers_2__Id"
name="AllQuestions[0].Answers[2].Id" type="hidden" value="118796"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_0__Answers_2__Label" name="AllQuestions[0].Answers[2].Label" type="hidden" value="Choking/Death"><input data-val="true"
data-val-required="The DisqualifyingAnswer field is required." id="AllQuestions_0__Answers_2__DisqualifyingAnswer" name="AllQuestions[0].Answers[2].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true"
data-val-required="The Id field is required." id="AllQuestions_0__Answers_3__Id" name="AllQuestions[0].Answers[3].Id" type="hidden" value="118797"><input data-val="true"
data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" data-val-required="The Label field is required." id="AllQuestions_0__Answers_3__Label"
name="AllQuestions[0].Answers[3].Label" type="hidden" value="Death due to COVID-19"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required." id="AllQuestions_0__Answers_3__DisqualifyingAnswer"
name="AllQuestions[0].Answers[3].DisqualifyingAnswer" type="hidden" value="True"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_0__Answers_4__Id" name="AllQuestions[0].Answers[4].Id" type="hidden"
value="118798"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" data-val-required="The Label field is required."
id="AllQuestions_0__Answers_4__Label" name="AllQuestions[0].Answers[4].Label" type="hidden" value="Fall"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_0__Answers_4__DisqualifyingAnswer" name="AllQuestions[0].Answers[4].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_0__Answers_5__Id"
name="AllQuestions[0].Answers[5].Id" type="hidden" value="118799"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_0__Answers_5__Label" name="AllQuestions[0].Answers[5].Label" type="hidden" value="Fractured Bones"><input data-val="true"
data-val-required="The DisqualifyingAnswer field is required." id="AllQuestions_0__Answers_5__DisqualifyingAnswer" name="AllQuestions[0].Answers[5].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true"
data-val-required="The Id field is required." id="AllQuestions_0__Answers_6__Id" name="AllQuestions[0].Answers[6].Id" type="hidden" value="118800"><input data-val="true"
data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" data-val-required="The Label field is required." id="AllQuestions_0__Answers_6__Label"
name="AllQuestions[0].Answers[6].Label" type="hidden" value="Infections"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required." id="AllQuestions_0__Answers_6__DisqualifyingAnswer"
name="AllQuestions[0].Answers[6].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_0__Answers_7__Id" name="AllQuestions[0].Answers[7].Id" type="hidden"
value="118801"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" data-val-required="The Label field is required."
id="AllQuestions_0__Answers_7__Label" name="AllQuestions[0].Answers[7].Label" type="hidden" value="Improper Treatment/Medication"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_0__Answers_7__DisqualifyingAnswer" name="AllQuestions[0].Answers[7].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_0__Answers_8__Id"
name="AllQuestions[0].Answers[8].Id" type="hidden" value="118802"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_0__Answers_8__Label" name="AllQuestions[0].Answers[8].Label" type="hidden" value="Malnutrition/Dehydration"><input data-val="true"
data-val-required="The DisqualifyingAnswer field is required." id="AllQuestions_0__Answers_8__DisqualifyingAnswer" name="AllQuestions[0].Answers[8].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true"
data-val-required="The Id field is required." id="AllQuestions_0__Answers_9__Id" name="AllQuestions[0].Answers[9].Id" type="hidden" value="118803"><input data-val="true"
data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" data-val-required="The Label field is required." id="AllQuestions_0__Answers_9__Label"
name="AllQuestions[0].Answers[9].Label" type="hidden" value="Respiratory Illness"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required." id="AllQuestions_0__Answers_9__DisqualifyingAnswer"
name="AllQuestions[0].Answers[9].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_0__Answers_10__Id" name="AllQuestions[0].Answers[10].Id" type="hidden"
value="118804"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" data-val-required="The Label field is required."
id="AllQuestions_0__Answers_10__Label" name="AllQuestions[0].Answers[10].Label" type="hidden" value="Sexual Abuse"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_0__Answers_10__DisqualifyingAnswer" name="AllQuestions[0].Answers[10].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_0__Answers_11__Id"
name="AllQuestions[0].Answers[11].Id" type="hidden" value="118805"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_0__Answers_11__Label" name="AllQuestions[0].Answers[11].Label" type="hidden" value="Other"><input data-val="true"
data-val-required="The DisqualifyingAnswer field is required." id="AllQuestions_0__Answers_11__DisqualifyingAnswer" name="AllQuestions[0].Answers[11].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true"
data-val-required="The Id field is required." id="AllQuestions_0__Answers_12__Id" name="AllQuestions[0].Answers[12].Id" type="hidden" value="118806"><input data-val="true"
data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" data-val-required="The Label field is required." id="AllQuestions_0__Answers_12__Label"
name="AllQuestions[0].Answers[12].Label" type="hidden" value="None of the above"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required." id="AllQuestions_0__Answers_12__DisqualifyingAnswer"
name="AllQuestions[0].Answers[12].DisqualifyingAnswer" type="hidden" value="False">
</div>
</div>
</div>
<div class="questionRow">
<div class="question-box">
<div class="">
<input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Id" name="AllQuestions[1].Id" type="hidden" value="162">
<input data-val="true" data-val-required="The Label field is required." id="AllQuestions_1__Label" name="AllQuestions[1].Label" type="hidden" value="State of Injury:">
<input data-val="true" data-val-required="The DisqualifyingQuestion field is required." id="AllQuestions_1__DisqualifyingQuestion" name="AllQuestions[1].DisqualifyingQuestion" type="hidden" value="False">
<input id="AllQuestions_1__SpecialType" name="AllQuestions[1].SpecialType" type="hidden" value="StateResidence">
<div style="display:flex; margin-right:1.25rem">
<label for="AllQuestions_1__Response" class="questionLabel">State of Injury:*</label>
</div>
<select id="AllQuestions_1__Response" name="AllQuestions[1].Response" required="true" class="formDropdown">
<option disabled="disabled" selected="selected" value="">Select</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AS">American Samoa</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="GU">Guam</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="MP">Northern Mariana Islands</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VI">U.S. Virgin Islands</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</select><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_0__Id" name="AllQuestions[1].Answers[0].Id" type="hidden" value="118807"><input data-val="true"
data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" data-val-required="The Label field is required." id="AllQuestions_1__Answers_0__Label"
name="AllQuestions[1].Answers[0].Label" type="hidden" value="AL"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required." id="AllQuestions_1__Answers_0__DisqualifyingAnswer"
name="AllQuestions[1].Answers[0].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_1__Id" name="AllQuestions[1].Answers[1].Id" type="hidden"
value="118808"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" data-val-required="The Label field is required."
id="AllQuestions_1__Answers_1__Label" name="AllQuestions[1].Answers[1].Label" type="hidden" value="AK"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required." id="AllQuestions_1__Answers_1__DisqualifyingAnswer"
name="AllQuestions[1].Answers[1].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_2__Id" name="AllQuestions[1].Answers[2].Id" type="hidden"
value="118809"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" data-val-required="The Label field is required."
id="AllQuestions_1__Answers_2__Label" name="AllQuestions[1].Answers[2].Label" type="hidden" value="AZ"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required." id="AllQuestions_1__Answers_2__DisqualifyingAnswer"
name="AllQuestions[1].Answers[2].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_3__Id" name="AllQuestions[1].Answers[3].Id" type="hidden"
value="118810"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" data-val-required="The Label field is required."
id="AllQuestions_1__Answers_3__Label" name="AllQuestions[1].Answers[3].Label" type="hidden" value="AR"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required." id="AllQuestions_1__Answers_3__DisqualifyingAnswer"
name="AllQuestions[1].Answers[3].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_4__Id" name="AllQuestions[1].Answers[4].Id" type="hidden"
value="118811"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" data-val-required="The Label field is required."
id="AllQuestions_1__Answers_4__Label" name="AllQuestions[1].Answers[4].Label" type="hidden" value="CA"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required." id="AllQuestions_1__Answers_4__DisqualifyingAnswer"
name="AllQuestions[1].Answers[4].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_5__Id" name="AllQuestions[1].Answers[5].Id" type="hidden"
value="118812"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" data-val-required="The Label field is required."
id="AllQuestions_1__Answers_5__Label" name="AllQuestions[1].Answers[5].Label" type="hidden" value="CO"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required." id="AllQuestions_1__Answers_5__DisqualifyingAnswer"
name="AllQuestions[1].Answers[5].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_6__Id" name="AllQuestions[1].Answers[6].Id" type="hidden"
value="118813"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" data-val-required="The Label field is required."
id="AllQuestions_1__Answers_6__Label" name="AllQuestions[1].Answers[6].Label" type="hidden" value="CT"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required." id="AllQuestions_1__Answers_6__DisqualifyingAnswer"
name="AllQuestions[1].Answers[6].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_7__Id" name="AllQuestions[1].Answers[7].Id" type="hidden"
value="118814"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" data-val-required="The Label field is required."
id="AllQuestions_1__Answers_7__Label" name="AllQuestions[1].Answers[7].Label" type="hidden" value="DE"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required." id="AllQuestions_1__Answers_7__DisqualifyingAnswer"
name="AllQuestions[1].Answers[7].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_8__Id" name="AllQuestions[1].Answers[8].Id" type="hidden"
value="118815"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" data-val-required="The Label field is required."
id="AllQuestions_1__Answers_8__Label" name="AllQuestions[1].Answers[8].Label" type="hidden" value="FL"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required." id="AllQuestions_1__Answers_8__DisqualifyingAnswer"
name="AllQuestions[1].Answers[8].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_9__Id" name="AllQuestions[1].Answers[9].Id" type="hidden"
value="118816"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" data-val-required="The Label field is required."
id="AllQuestions_1__Answers_9__Label" name="AllQuestions[1].Answers[9].Label" type="hidden" value="GA"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required." id="AllQuestions_1__Answers_9__DisqualifyingAnswer"
name="AllQuestions[1].Answers[9].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_10__Id" name="AllQuestions[1].Answers[10].Id" type="hidden"
value="118817"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" data-val-required="The Label field is required."
id="AllQuestions_1__Answers_10__Label" name="AllQuestions[1].Answers[10].Label" type="hidden" value="HI"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_10__DisqualifyingAnswer" name="AllQuestions[1].Answers[10].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_11__Id"
name="AllQuestions[1].Answers[11].Id" type="hidden" value="118818"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_11__Label" name="AllQuestions[1].Answers[11].Label" type="hidden" value="ID"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_11__DisqualifyingAnswer" name="AllQuestions[1].Answers[11].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_12__Id"
name="AllQuestions[1].Answers[12].Id" type="hidden" value="118819"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_12__Label" name="AllQuestions[1].Answers[12].Label" type="hidden" value="IL"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_12__DisqualifyingAnswer" name="AllQuestions[1].Answers[12].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_13__Id"
name="AllQuestions[1].Answers[13].Id" type="hidden" value="118820"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_13__Label" name="AllQuestions[1].Answers[13].Label" type="hidden" value="IN"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_13__DisqualifyingAnswer" name="AllQuestions[1].Answers[13].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_14__Id"
name="AllQuestions[1].Answers[14].Id" type="hidden" value="118821"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_14__Label" name="AllQuestions[1].Answers[14].Label" type="hidden" value="IA"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_14__DisqualifyingAnswer" name="AllQuestions[1].Answers[14].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_15__Id"
name="AllQuestions[1].Answers[15].Id" type="hidden" value="118822"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_15__Label" name="AllQuestions[1].Answers[15].Label" type="hidden" value="KS"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_15__DisqualifyingAnswer" name="AllQuestions[1].Answers[15].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_16__Id"
name="AllQuestions[1].Answers[16].Id" type="hidden" value="118823"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_16__Label" name="AllQuestions[1].Answers[16].Label" type="hidden" value="KY"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_16__DisqualifyingAnswer" name="AllQuestions[1].Answers[16].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_17__Id"
name="AllQuestions[1].Answers[17].Id" type="hidden" value="118824"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_17__Label" name="AllQuestions[1].Answers[17].Label" type="hidden" value="LA"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_17__DisqualifyingAnswer" name="AllQuestions[1].Answers[17].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_18__Id"
name="AllQuestions[1].Answers[18].Id" type="hidden" value="118825"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_18__Label" name="AllQuestions[1].Answers[18].Label" type="hidden" value="ME"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_18__DisqualifyingAnswer" name="AllQuestions[1].Answers[18].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_19__Id"
name="AllQuestions[1].Answers[19].Id" type="hidden" value="118826"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_19__Label" name="AllQuestions[1].Answers[19].Label" type="hidden" value="MD"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_19__DisqualifyingAnswer" name="AllQuestions[1].Answers[19].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_20__Id"
name="AllQuestions[1].Answers[20].Id" type="hidden" value="118827"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_20__Label" name="AllQuestions[1].Answers[20].Label" type="hidden" value="MA"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_20__DisqualifyingAnswer" name="AllQuestions[1].Answers[20].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_21__Id"
name="AllQuestions[1].Answers[21].Id" type="hidden" value="118828"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_21__Label" name="AllQuestions[1].Answers[21].Label" type="hidden" value="MI"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_21__DisqualifyingAnswer" name="AllQuestions[1].Answers[21].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_22__Id"
name="AllQuestions[1].Answers[22].Id" type="hidden" value="118829"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_22__Label" name="AllQuestions[1].Answers[22].Label" type="hidden" value="MN"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_22__DisqualifyingAnswer" name="AllQuestions[1].Answers[22].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_23__Id"
name="AllQuestions[1].Answers[23].Id" type="hidden" value="118830"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_23__Label" name="AllQuestions[1].Answers[23].Label" type="hidden" value="MS"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_23__DisqualifyingAnswer" name="AllQuestions[1].Answers[23].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_24__Id"
name="AllQuestions[1].Answers[24].Id" type="hidden" value="118831"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_24__Label" name="AllQuestions[1].Answers[24].Label" type="hidden" value="MO"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_24__DisqualifyingAnswer" name="AllQuestions[1].Answers[24].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_25__Id"
name="AllQuestions[1].Answers[25].Id" type="hidden" value="118832"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_25__Label" name="AllQuestions[1].Answers[25].Label" type="hidden" value="MT"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_25__DisqualifyingAnswer" name="AllQuestions[1].Answers[25].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_26__Id"
name="AllQuestions[1].Answers[26].Id" type="hidden" value="118833"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_26__Label" name="AllQuestions[1].Answers[26].Label" type="hidden" value="NE"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_26__DisqualifyingAnswer" name="AllQuestions[1].Answers[26].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_27__Id"
name="AllQuestions[1].Answers[27].Id" type="hidden" value="118834"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_27__Label" name="AllQuestions[1].Answers[27].Label" type="hidden" value="NV"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_27__DisqualifyingAnswer" name="AllQuestions[1].Answers[27].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_28__Id"
name="AllQuestions[1].Answers[28].Id" type="hidden" value="118835"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_28__Label" name="AllQuestions[1].Answers[28].Label" type="hidden" value="NH"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_28__DisqualifyingAnswer" name="AllQuestions[1].Answers[28].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_29__Id"
name="AllQuestions[1].Answers[29].Id" type="hidden" value="118836"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_29__Label" name="AllQuestions[1].Answers[29].Label" type="hidden" value="NJ"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_29__DisqualifyingAnswer" name="AllQuestions[1].Answers[29].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_30__Id"
name="AllQuestions[1].Answers[30].Id" type="hidden" value="118837"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_30__Label" name="AllQuestions[1].Answers[30].Label" type="hidden" value="NM"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_30__DisqualifyingAnswer" name="AllQuestions[1].Answers[30].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_31__Id"
name="AllQuestions[1].Answers[31].Id" type="hidden" value="118838"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_31__Label" name="AllQuestions[1].Answers[31].Label" type="hidden" value="NY"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_31__DisqualifyingAnswer" name="AllQuestions[1].Answers[31].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_32__Id"
name="AllQuestions[1].Answers[32].Id" type="hidden" value="118839"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_32__Label" name="AllQuestions[1].Answers[32].Label" type="hidden" value="NC"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_32__DisqualifyingAnswer" name="AllQuestions[1].Answers[32].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_33__Id"
name="AllQuestions[1].Answers[33].Id" type="hidden" value="118840"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_33__Label" name="AllQuestions[1].Answers[33].Label" type="hidden" value="ND"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_33__DisqualifyingAnswer" name="AllQuestions[1].Answers[33].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_34__Id"
name="AllQuestions[1].Answers[34].Id" type="hidden" value="118841"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_34__Label" name="AllQuestions[1].Answers[34].Label" type="hidden" value="OH"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_34__DisqualifyingAnswer" name="AllQuestions[1].Answers[34].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_35__Id"
name="AllQuestions[1].Answers[35].Id" type="hidden" value="118842"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_35__Label" name="AllQuestions[1].Answers[35].Label" type="hidden" value="OK"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_35__DisqualifyingAnswer" name="AllQuestions[1].Answers[35].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_36__Id"
name="AllQuestions[1].Answers[36].Id" type="hidden" value="118843"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_36__Label" name="AllQuestions[1].Answers[36].Label" type="hidden" value="OR"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_36__DisqualifyingAnswer" name="AllQuestions[1].Answers[36].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_37__Id"
name="AllQuestions[1].Answers[37].Id" type="hidden" value="118844"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_37__Label" name="AllQuestions[1].Answers[37].Label" type="hidden" value="PA"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_37__DisqualifyingAnswer" name="AllQuestions[1].Answers[37].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_38__Id"
name="AllQuestions[1].Answers[38].Id" type="hidden" value="118845"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_38__Label" name="AllQuestions[1].Answers[38].Label" type="hidden" value="RI"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_38__DisqualifyingAnswer" name="AllQuestions[1].Answers[38].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_39__Id"
name="AllQuestions[1].Answers[39].Id" type="hidden" value="118846"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_39__Label" name="AllQuestions[1].Answers[39].Label" type="hidden" value="SC"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_39__DisqualifyingAnswer" name="AllQuestions[1].Answers[39].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_40__Id"
name="AllQuestions[1].Answers[40].Id" type="hidden" value="118847"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_40__Label" name="AllQuestions[1].Answers[40].Label" type="hidden" value="SD"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_40__DisqualifyingAnswer" name="AllQuestions[1].Answers[40].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_41__Id"
name="AllQuestions[1].Answers[41].Id" type="hidden" value="118848"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_41__Label" name="AllQuestions[1].Answers[41].Label" type="hidden" value="TN"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_41__DisqualifyingAnswer" name="AllQuestions[1].Answers[41].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_42__Id"
name="AllQuestions[1].Answers[42].Id" type="hidden" value="118849"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_42__Label" name="AllQuestions[1].Answers[42].Label" type="hidden" value="TX"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_42__DisqualifyingAnswer" name="AllQuestions[1].Answers[42].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_43__Id"
name="AllQuestions[1].Answers[43].Id" type="hidden" value="118850"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_43__Label" name="AllQuestions[1].Answers[43].Label" type="hidden" value="UT"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_43__DisqualifyingAnswer" name="AllQuestions[1].Answers[43].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_44__Id"
name="AllQuestions[1].Answers[44].Id" type="hidden" value="118851"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_44__Label" name="AllQuestions[1].Answers[44].Label" type="hidden" value="VT"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_44__DisqualifyingAnswer" name="AllQuestions[1].Answers[44].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_45__Id"
name="AllQuestions[1].Answers[45].Id" type="hidden" value="118852"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_45__Label" name="AllQuestions[1].Answers[45].Label" type="hidden" value="VA"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_45__DisqualifyingAnswer" name="AllQuestions[1].Answers[45].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_46__Id"
name="AllQuestions[1].Answers[46].Id" type="hidden" value="118853"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_46__Label" name="AllQuestions[1].Answers[46].Label" type="hidden" value="WA"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_46__DisqualifyingAnswer" name="AllQuestions[1].Answers[46].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_47__Id"
name="AllQuestions[1].Answers[47].Id" type="hidden" value="118854"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_47__Label" name="AllQuestions[1].Answers[47].Label" type="hidden" value="WV"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_47__DisqualifyingAnswer" name="AllQuestions[1].Answers[47].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_48__Id"
name="AllQuestions[1].Answers[48].Id" type="hidden" value="118855"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_48__Label" name="AllQuestions[1].Answers[48].Label" type="hidden" value="WY"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_48__DisqualifyingAnswer" name="AllQuestions[1].Answers[48].DisqualifyingAnswer" type="hidden" value="False"><input data-val="true" data-val-required="The Id field is required." id="AllQuestions_1__Answers_49__Id"
name="AllQuestions[1].Answers[49].Id" type="hidden" value="118856"><input data-val="true" data-val-maxlength="The field Label must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100"
data-val-required="The Label field is required." id="AllQuestions_1__Answers_49__Label" name="AllQuestions[1].Answers[49].Label" type="hidden" value="WI"><input data-val="true" data-val-required="The DisqualifyingAnswer field is required."
id="AllQuestions_1__Answers_49__DisqualifyingAnswer" name="AllQuestions[1].Answers[49].DisqualifyingAnswer" type="hidden" value="False">
</div>
</div>
<div class="question-box">
<div class="">
<input data-val="true" data-val-required="The Id field is required." id="AllQuestions_2__Id" name="AllQuestions[2].Id" type="hidden" value="169">
<input data-val="true" data-val-required="The Label field is required." id="AllQuestions_2__Label" name="AllQuestions[2].Label" type="hidden" value="Year of Injury:">
<input data-val="true" data-val-required="The DisqualifyingQuestion field is required." id="AllQuestions_2__DisqualifyingQuestion" name="AllQuestions[2].DisqualifyingQuestion" type="hidden" value="True">
<div style="display:flex; margin-right:1.25rem">
<label for="AllQuestions_2__Response" class="questionLabel">Year of Injury:*</label>
</div>
<select id="AllQuestions_2__Response" name="AllQuestions[2].Response" required="true" class="formDropdown">
<option disabled="disabled" selected="selected" value="">Select</option>
<option value="2023">2023</option>
<option value="2022">2022</option>
<option value="2021">2021</option>
<option value="2020 and prior">2020 and prior</option>
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10 15 NursingHomeLawyer@Pintas.com 800-725-9877 Thank You For Submitting Your Information 1 Nursing Home Claims 800-725-9877 FREE NATIONWIDE CONSULTATION 24/7 800-725-9877 If your loved one has been neglected, abused, or harmed in a Nursing Home, they may be entitled to compensation. If your loved one has been neglected, abused, or harmed in a Nursing Home, they may be entitled to compensation. Please fill out the form below for a free and confidential case review. Has your loved one experienced any of the following in a Nursing Home or Assisted Living Facility?* Select Bedsores Bowel Impaction Choking/Death Death due to COVID-19 Fall Fractured Bones Infections Improper Treatment/Medication Malnutrition/Dehydration Respiratory Illness Sexual Abuse Other None of the above State of Injury:* Select Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont U.S. Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Year of Injury:* Select 2023 2022 2021 2020 and prior Relationship to injured loved one:* Select Myself Parent or Child Sibling Spouse Other Family Member Friend First Name* Last Name* Phone Number* Email* Contact Preference Call Text Email Additional Comments (500 Character Max) You May Have A Case! Based on the information you provided to us, it appears that our experienced lawyers may be able to help you! Click the button below to sign a contract with us: Sign Up Now See If You Qualify NURSING HOME NEGLECT IS A NATIONAL CRISIS The U.S. has thousands of long-term care facilities serving millions of residents. Neglect and injuries are consistent and growing problems in Skilled Nursing Facilities (SNF), Assisted Living Facilities (ALF), and Community Integrated Living Arrangements (CILA). If you believe a loved one is being abused or neglected in one of these facilities, report the mistreatment as soon as possible. Filing a claim helps protect your loved one and can prevent future abuse of others. * No Fees Charged Until We Win Your Case * 100% Confidential Review and Settlement Process * Meet our Attorneys In Person or Over the Phone NURSING HOME NEGLECT IS A NATIONAL CRISIS SIGNS OF NEGLECT AND ABUSE If nursing home residents spend most of their time in a bed or chair without being moved by a nursing home attendant, bedsores can develop on their hips, feet, joints, and back-- wherever bones press against fragile skin. If left untreated, bedsores can cause infection, hospitalization, and even death. Bedsores Falls are the most common cause of bone fractures in nursing home residents. It is the staff’s responsibility to prevent residents from falling by constantly monitoring them, carefully moving them, and assisting with walking. Bone Fractures And Breaks Falls can be caused by any number of things – from medications to malnutrition. Most falls can be prevented by nursing home staff. If your loved one suffered a fall, make sure it was not due to mistreatment, abuse, or neglect. Falls Residents who don’t get proper nutrition and hydration are at higher risk for bedsores, infections, and falls. Nursing homes must prevent malnutrition by carefully logging how much residents eat, offering a comfortable environment to eat in, and serving appetizing food. Malnutrition Medication Errors Medication errors are often due to the negligence of nursing home staff. Errors such as distributing the wrong medication or the wrong dosage to a resident can be potentially fatal, as medications may be essential for a resident’s survival. One of the most dangerous and severe medication errors is overmedicating residents. Elderly people who are abused have a 300% higher risk of death than those who are not. Nursing home residents are common targets for abuse and neglect. If your loved one died suddenly or suspiciously, their nursing facility may be to blame. Death Nursing home residents are particularly vulnerable to sexual abuse. Many with advanced dementia cannot tell their families what is happening, so loved ones must be hyper-aware of this threat. Signs of sexual abuse include sexually transmitted infections, unexplained cuts or bruising, bleeding in the genital area, and extreme fear of a staff member or other resident. Sexual Abuse Signs of Neglect And Abuse About Us At Pintas & Mullins Law Firm, the personalized, quality legal representation we’ve provided for more than 35 years means everything to our clients. Just as we have always done, we will aggressively pursue your rights and take care of the legal process so you can focus on the immediate health and safety of you and your family. Our claim review process is completely free and confidential. We do not get paid unless you win. We’ve represented more than 10,000 nursing home clients throughout the country, and understand what it takes and have the experience to win these cases. Free Case Review Settlement for a California nursing home resident who suffered multiple fractures from a fall. He was 74 and suffered from dementia. The case was settled within a matter of months. RECENT CASE RESULTS $1.7 Million Settlement for a 78-year-old man who developed a bedsore at an Illinois nursing home. He had no skin issues when he was moved to the home to rehabilitate following a stroke. $1.35 Million $1 Million Settlement for a California woman who eloped from a nursing home due to negligent staff and then fractured her femur due to a fall. She was 94 years old, suffering from dementia and known to be a fall risk. $1 Million Settlement for a California man who was admitted to the ICU after he developed a Stage 4 bedsore due to the negligence of nursing home staff. The patient had already suffered from a misdiagnosis and faulty surgery before he arrived at the home. $950,000 Settlement for a nursing home patient in Georgia who was admitted to the ICU after developing sepsis from a bedsore as well as a colon infection. This had been caused by her nursing home’s negligence. The case was settled with her estate. $1 Million Settlement for a 72-year-old woman who was sexually assaulted by a male employee while living in a rehabilitation center. Settlement for a client with severe bedsores during her stay at a nursing home. Her family was deeply unhappy with her care and had her transferred. $1 Million Settlement for a nursing home resident who fell out of his wheelchair and suffered a serious head injury that eventually led to his death. $1.4 Million Client testimonials T S "The Law Firm of Pintas & Mullins has been very helpful... with the representation of my daughter’s case. Emily specifically has been very professional, informative, straightforward, compassionate, extremely courteous, helpful, and patient. If you are in need of good legal representation, I would highly recommend them." Google Kimberly "Sheila really helped out getting my case together listened to everything took her time making sure I was comfortable informed me about the process. It's really great that they are right behind you helping you.. Thank you so much Sheila for your kindness and professionalism. I do feel like my claim is in the best hands." Google Jamison "My experience was totally and genuinely pleasant. I spoke with a young lady named Ty... She was very patient and she also happened to give me optimism whether she knew it or not. I will gladly recommend this firm to anyone who not only needs a lawyer that's going to fight... but also one that will be empathetic." Google Client testimonials CONTACT US TODAY FOR A FREE CONSULTATION If your loved one has suffered injury or been mistreated in any way while in the care of a nursing home, they may be entitled to significant compensation. We can guide you through the legal process with compassion and expertise. Reach out to us today. We are here to help. File Your Claim Request THIS IS A PAID LEGAL ADVERTISEMENT. Hiring an attorney is a serious matter and should not be based solely upon advertising. Past performance is no guarantee of future results. In the absence of recovery, the client is NOT liable for attorney fees. Pintas & Mullins Law Firm PR, LLC is a law firm located at 250 Ave. Luis Muñoz Rivera, Suite 300, San Juan, PR 00918. William Pintas and Laura Mullins are licensed in Illinois and will maintain professional and financial responsibility on accepted cases even when they may partner with firms in other states where licensing may be required. Not available in all states. Submitting...