{ "document_id": 16157, "page": 7, "width_pt": 612, "height_pt": 792, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "engine": "paddleocr_vl", "source_run_id": 16267, "item_count": 30, "counts_by_type": { "caption": 1, "form_field": 10, "heading": 1, "list": 1, "list_item": 2, "table": 1, "table_cell": 10, "text": 4 }, "build_ms": 3, "items": [ { "id": "p7.1", "order": 1, "type": "table", "bbox": { "l": 49.44, "t": 742.632, "r": 516.48, "b": 671.52 }, "text": "", "attrs": { "block_label": "table", "n_rows": 2, "n_cols": 5, "integrity": { "cells_checked": 5, "cells_flagged": 0 } }, "children": [ { "id": "p7.1.1", "order": 2, "type": "table_cell", "bbox": { "l": 57.6, "t": 742.632, "r": 93.996, "b": 698.424 }, "text": "Check all that apply", "attrs": { "row": 0, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p7.1.2", "order": 3, "type": "table_cell", "bbox": { "l": 142.848, "t": 742.32, "r": 236.256, "b": 706.92 }, "text": "", "attrs": { "row": 0, "col": 1, "rowspan": 1, "colspan": 1, "column_header": true, "header_source": "pdf" } }, { "id": "p7.1.3", "order": 4, "type": "table_cell", "bbox": { "l": 345.6, "t": 742.632, "r": 364.956, "b": 726.024 }, "text": "Self", "attrs": { "row": 0, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p7.1.4", "order": 5, "type": "table_cell", "bbox": { "l": 384.12, "t": 742.632, "r": 438.912, "b": 712.224 }, "text": "Household member", "attrs": { "row": 0, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p7.1.5", "order": 6, "type": "table_cell", "bbox": { "l": 467.4, "t": 742.632, "r": 496.152, "b": 726.024 }, "text": "Child", "attrs": { "row": 0, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p7.1.6", "order": 7, "type": "table_cell", "bbox": { "l": 49.44, "t": 706.92, "r": 142.848, "b": 671.52 }, "text": "□", "attrs": { "row": 1, "col": 0, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p7.1.6.1", "order": 8, "type": "form_field", "bbox": { "l": 68.52, "t": 695.4, "r": 83.04, "b": 676.8 }, "text": "", "attrs": { "field_kind": "checkbox", "label": "□", "pdf_field_name": "Checkbox148(CRAHV)", "source": "acroform", "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "text_offset": 0, "text_span": 1 } } ] }, { "id": "p7.1.7", "order": 9, "type": "table_cell", "bbox": { "l": 106.44, "t": 700.56, "r": 137.016, "b": 684.396 }, "text": "Other:", "attrs": { "row": 1, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "children": [ { "id": "p7.1.7.1", "order": 10, "type": "form_field", "bbox": { "l": 140.04, "t": 699, "r": 326.16, "b": 686.76 }, "text": "", "attrs": { "field_kind": "text", "label": "Other:", "pdf_field_name": "Other(CRAHV)", "source": "acroform", "row": 1, "col": 1, "rowspan": 1, "colspan": 1, "label_source": "parent_text", "label_ref": "p7.1.7", "text_offset": 6, "text_span": 0 } } ] }, { "id": "p7.1.8", "order": 11, "type": "table_cell", "bbox": { "l": 236.256, "t": 706.92, "r": 329.664, "b": 671.52 }, "text": "□", "attrs": { "row": 1, "col": 2, "rowspan": 1, "colspan": 1 } }, { "id": "p7.1.9", "order": 12, "type": "table_cell", "bbox": { "l": 329.664, "t": 706.92, "r": 423.072, "b": 671.52 }, "text": "□", "attrs": { "row": 1, "col": 3, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p7.1.9.1", "order": 13, "type": "form_field", "bbox": { "l": 348.293, "t": 695.234, "r": 362.813, "b": 676.634 }, "text": "", "attrs": { "field_kind": "checkbox", "label": "□", "pdf_field_name": "Checkbox149(CRAHV)", "source": "acroform", "row": 1, "col": 3, "rowspan": 1, "colspan": 1, "text_offset": 0, "text_span": 1 } }, { "id": "p7.1.9.2", "order": 14, "type": "form_field", "bbox": { "l": 404.165, "t": 695.105, "r": 418.685, "b": 676.505 }, "text": "", "attrs": { "field_kind": "checkbox", "label": "□", "pdf_field_name": "Checkbox150(CRAHV)", "source": "acroform", "row": 1, "col": 3, "rowspan": 1, "colspan": 1, "text_offset": 0, "text_span": 0 } } ] }, { "id": "p7.1.10", "order": 15, "type": "table_cell", "bbox": { "l": 423.072, "t": 706.92, "r": 516.48, "b": 671.52 }, "text": "□", "attrs": { "row": 1, "col": 4, "rowspan": 1, "colspan": 1 }, "children": [ { "id": "p7.1.10.1", "order": 16, "type": "form_field", "bbox": { "l": 475.133, "t": 695.364, "r": 489.653, "b": 676.764 }, "text": "", "attrs": { "field_kind": "checkbox", "label": "□", "pdf_field_name": "Checkbox151(CRAHV)", "source": "acroform", "row": 1, "col": 4, "rowspan": 1, "colspan": 1, "text_offset": 0, "text_span": 1 } } ] } ] }, { "id": "p7.2", "order": 17, "type": "caption", "bbox": { "l": 47.28, "t": 656.88, "r": 532.8, "b": 626.16 }, "text": "4. If you checked a box in (2) or (3), list any evaluation, counseling, or other treatment received as a result:", "attrs": { "block_label": "figure_title" } }, { "id": "p7.3", "order": 18, "type": "form_field", "bbox": { "l": 49.162, "t": 627.482, "r": 552.199, "b": 532.706 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Question 4(CRAHV)", "source": "acroform" } }, { "id": "p7.4", "order": 19, "type": "list", "bbox": { "l": 47.28, "t": 530.16, "r": 554.64, "b": 371.76 }, "text": "", "attrs": { "item_count": 2 }, "children": [ { "id": "p7.4.1", "order": 20, "type": "list_item", "bbox": { "l": 47.28, "t": 530.16, "r": 554.64, "b": 498 }, "text": "If you checked a box in (2) or (3) that applies to your household member, who is not a party, state that person's name, date of birth, and relationship to the child.", "marker": "5." }, { "id": "p7.4.2", "order": 21, "type": "list_item", "bbox": { "l": 47.28, "t": 403.2, "r": 543.36, "b": 371.76 }, "text": "If you are aware that the other party or the other party's household member has a criminal record or abuse history, please explain.", "marker": "6." }, { "id": "p7.4.3", "order": 22, "type": "form_field", "bbox": { "l": 49.0662, "t": 498.738, "r": 552.103, "b": 403.963 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Question 5(CRAHV)", "source": "acroform" } } ] }, { "id": "p7.5", "order": 23, "type": "form_field", "bbox": { "l": 48.808, "t": 372.414, "r": 551.845, "b": 277.638 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Question 6(CRAHV)", "source": "acroform" } }, { "id": "p7.6", "order": 24, "type": "heading", "bbox": { "l": 46.56, "t": 261.84, "r": 549.84, "b": 234 }, "text": "ONLY A PARTY CAN SIGN THIS FORM. IF A PARTY IS REPRESENTED BY AN ATTORNEY, THE ATTORNEY CANNOT SIGN THIS FORM ON BEHALF OF THE PARTY.", "attrs": { "block_label": "paragraph_title" }, "level": 3 }, { "id": "p7.7", "order": 25, "type": "text", "bbox": { "l": 47.04, "t": 220.8, "r": 562.8, "b": 178.32 }, "text": "I verify that the information above is true and correct to the best of my knowledge, information or belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities." }, { "id": "p7.8", "order": 26, "type": "text", "bbox": { "l": 51.12, "t": 145.68, "r": 178.32, "b": 136.08 }, "text": "___" }, { "id": "p7.9", "order": 27, "type": "text", "bbox": { "l": 263.28, "t": 140.16, "r": 484.8, "b": 81.84 }, "text": "Plaintiff/Defendant Signature\n(Printed Name)", "children": [ { "id": "p7.9.1", "order": 28, "type": "form_field", "bbox": { "l": 266.4, "t": 121.866, "r": 482.4, "b": 98.4 }, "text": "", "attrs": { "field_kind": "text", "label": "Printed Name", "pdf_field_name": "Printed Name(CRAHV)", "source": "acroform", "label_source": "parent_text", "label_ref": "p7.9" } } ] }, { "id": "p7.10", "order": 29, "type": "text", "bbox": { "l": 48.48, "t": 136.8, "r": 178.08, "b": 123.84 }, "text": "Date", "children": [ { "id": "p7.10.1", "order": 30, "type": "form_field", "bbox": { "l": 50.4, "t": 160.943, "r": 176.4, "b": 139.8 }, "text": "", "attrs": { "field_kind": "text", "label": "Date", "pdf_field_name": "Date(CRAHV)", "source": "acroform", "label_source": "parent_text", "label_ref": "p7.10" } } ] } ], "excluded_furniture": { "first": [], "last": [] } }