[
    {
        "page": 1,
        "items": [
            {
                "page": 1,
                "type": "TITLE",
                "location": {
                    "l": 234.48,
                    "t": 733.68,
                    "r": 412.32,
                    "b": 721.68
                },
                "text": "MISSISSIPPI STATE DEPARTMENT OF HEALTH",
                "reading_order": 0,
                "level": 3
            },
            {
                "page": 1,
                "type": "TITLE",
                "location": {
                    "l": 154.08,
                    "t": 718.56,
                    "r": 474.48,
                    "b": 700.8
                },
                "text": "NEWBORN SCREENING SUPPLY FORM",
                "reading_order": 1,
                "level": 2
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 690.24,
                    "r": 541.2,
                    "b": 670.6029
                },
                "text": "Requested by: Date:",
                "reading_order": 2
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 139.44,
                    "t": 687.48,
                    "r": 377.04,
                    "b": 658.68
                },
                "text": "Requested by:",
                "field_kind": "text",
                "label": "Requested by:",
                "pdf_field_name": "Requested by",
                "pdf_field_type": "Text",
                "reading_order": 3
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 406.56,
                    "t": 687.48,
                    "r": 539.16,
                    "b": 667.189
                },
                "text": "Date:",
                "field_kind": "text",
                "label": "Date:",
                "pdf_field_name": "Date",
                "pdf_field_type": "Text",
                "reading_order": 4
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 670.6029,
                    "r": 541.2,
                    "b": 631.3286
                },
                "text": "Shipping Address: ATTN:",
                "reading_order": 5
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 414.84,
                    "t": 655.8,
                    "r": 539.16,
                    "b": 634.855
                },
                "text": "ATTN:",
                "field_kind": "text",
                "label": "ATTN:",
                "pdf_field_name": "ATTN",
                "pdf_field_type": "Text",
                "reading_order": 6
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 228.24,
                    "t": 650.9657,
                    "r": 541.2,
                    "b": 631.3286
                },
                "text": "Phone:",
                "reading_order": 7
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 631.3286,
                    "r": 541.2,
                    "b": 611.6914
                },
                "text": "Resource Description Quantity Requested Quantity Shipped",
                "reading_order": 8
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 78.7087,
                    "t": 642.825,
                    "r": 376.8,
                    "b": 610.84
                },
                "text": "Shipping Address:",
                "field_kind": "text",
                "label": "Shipping Address:",
                "pdf_field_name": "Shipping Address",
                "pdf_field_type": "Text",
                "reading_order": 9
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 412.8,
                    "t": 625.8,
                    "r": 539.52,
                    "b": 609.84
                },
                "text": "Phone:",
                "field_kind": "text",
                "label": "Phone:",
                "pdf_field_name": "Phone",
                "pdf_field_type": "Text",
                "reading_order": 10
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 611.6914,
                    "r": 541.2,
                    "b": 592.0543
                },
                "text": "Newborn Screening Dried Blood Spot Cards “Filter Paper”",
                "reading_order": 11
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 592.0543,
                    "r": 541.2,
                    "b": 572.4171
                },
                "text": "Newborn Screening Pamphlet (#5198 English)",
                "reading_order": 12
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 378.96,
                    "t": 581.16,
                    "r": 462.72,
                    "b": 565.2
                },
                "text": "Quantity Requested_Newborn Screening Dried Blood Spot Cards “Filter Paper”",
                "field_kind": "text",
                "label": "Quantity Requested_Newborn Screening Dried Blood Spot Cards “Filter Paper”",
                "pdf_field_name": "Quantity RequestedNewborn Screening Dried Blood Spot Cards Filter Paper",
                "pdf_field_type": "Text",
                "reading_order": 13
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 572.4171,
                    "r": 541.2,
                    "b": 552.78
                },
                "text": "Newborn Screening Pamphlet (#5198 Spanish)",
                "reading_order": 14
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 378.96,
                    "t": 564,
                    "r": 462.72,
                    "b": 548.04
                },
                "text": "Quantity Requested_Newborn Screening Pamphlet (#5198 English)",
                "field_kind": "text",
                "label": "Quantity Requested_Newborn Screening Pamphlet (#5198 English)",
                "pdf_field_name": "Quantity RequestedNewborn Screening Pamphlet 5198 English",
                "pdf_field_type": "Text",
                "reading_order": 15
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 552.78,
                    "r": 541.2,
                    "b": 533.1429
                },
                "text": "Screening for Critical Congenital Heart Defects (English)",
                "reading_order": 16
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 378.96,
                    "t": 546.84,
                    "r": 462.72,
                    "b": 530.88
                },
                "text": "Quantity Requested_Newborn Screening Pamphlet (#5198 Spanish)",
                "field_kind": "text",
                "label": "Quantity Requested_Newborn Screening Pamphlet (#5198 Spanish)",
                "pdf_field_name": "Quantity RequestedNewborn Screening Pamphlet 5198 Spanish",
                "pdf_field_type": "Text",
                "reading_order": 17
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 533.1429,
                    "r": 541.2,
                    "b": 513.5057
                },
                "text": "5 Things to Know About Congenital Heart Defects (English)",
                "reading_order": 18
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 378.96,
                    "t": 529.68,
                    "r": 462.72,
                    "b": 513.72
                },
                "text": "Quantity Requested_Screening for Critical Congenital Heart Defects (English)",
                "field_kind": "text",
                "label": "Quantity Requested_Screening for Critical Congenital Heart Defects (English)",
                "pdf_field_name": "Quantity RequestedScreening for Critical Congenital Heart Defects English",
                "pdf_field_type": "Text",
                "reading_order": 19
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 513.5057,
                    "r": 541.2,
                    "b": 493.8686
                },
                "text": "The Basics of Safe Sleep Tri-Fold Brochure",
                "reading_order": 20
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 378.96,
                    "t": 512.52,
                    "r": 462.72,
                    "b": 496.68
                },
                "text": "Quantity Requested_5 Things to Know About Congenital Heart Defects (English)",
                "field_kind": "text",
                "label": "Quantity Requested_5 Things to Know About Congenital Heart Defects (English)",
                "pdf_field_name": "Quantity Requested5 Things to Know About Congenital Heart Defects English",
                "pdf_field_type": "Text",
                "reading_order": 21
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 493.8686,
                    "r": 541.2,
                    "b": 474.2314
                },
                "text": "Baby’s Safe Sleep Crib Checklist (#5400 English)",
                "reading_order": 22
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 378.96,
                    "t": 495.48,
                    "r": 462.72,
                    "b": 479.52
                },
                "text": "Quantity Requested_What Does a Safe Sleep Environment Look Like (#5404 English)",
                "field_kind": "text",
                "label": "Quantity Requested_What Does a Safe Sleep Environment Look Like (#5404 English)",
                "pdf_field_name": "Quantity RequestedWhat Does a Safe Sleep Environment Look Like 5404 English",
                "pdf_field_type": "Text",
                "reading_order": 23
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 474.2314,
                    "r": 541.2,
                    "b": 454.5943
                },
                "text": "Baby’s Safe Sleep Crib Checklist (#5400 Spanish)",
                "reading_order": 24
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 378.96,
                    "t": 478.32,
                    "r": 462.72,
                    "b": 462.48
                },
                "text": "Quantity Requested_What Does a Safe Sleep Environment Look Like (#5404S Spanish)",
                "field_kind": "text",
                "label": "Quantity Requested_What Does a Safe Sleep Environment Look Like (#5404S Spanish)",
                "pdf_field_name": "Quantity RequestedWhat Does a Safe Sleep Environment Look Like 5404S Spanish",
                "pdf_field_type": "Text",
                "reading_order": 25
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 454.5943,
                    "r": 541.2,
                    "b": 434.9571
                },
                "text": "Safe Sleep Routine for Baby (English)",
                "reading_order": 26
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 378.96,
                    "t": 461.28,
                    "r": 462.72,
                    "b": 445.32
                },
                "text": "Quantity Requested_Baby’s Safe Sleep Crib Checklist (#5400 English)",
                "field_kind": "text",
                "label": "Quantity Requested_Baby’s Safe Sleep Crib Checklist (#5400 English)",
                "pdf_field_name": "Quantity RequestedBabys Safe Sleep Crib Checklist 5400 English",
                "pdf_field_type": "Text",
                "reading_order": 27
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 378.96,
                    "t": 444.12,
                    "r": 462.72,
                    "b": 428.16
                },
                "text": "Quantity Requested_Safe Sleep Routine for Baby (English)",
                "field_kind": "text",
                "label": "Quantity Requested_Safe Sleep Routine for Baby (English)",
                "pdf_field_name": "Quantity RequestedSafe Sleep Routine for Baby English",
                "pdf_field_type": "Text",
                "reading_order": 28
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 434.9571,
                    "r": 541.2,
                    "b": 415.32
                },
                "text": "Newborn Hearing Screening: What to Expect (#5272 English)",
                "reading_order": 29
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 378.96,
                    "t": 426.96,
                    "r": 462.72,
                    "b": 411
                },
                "text": "Quantity Requested_Newborn Hearing Screening: What to Expect (#5272 English)",
                "field_kind": "text",
                "label": "Quantity Requested_Newborn Hearing Screening: What to Expect (#5272 English)",
                "pdf_field_name": "Quantity RequestedNewborn Hearing Screening What to Expect 5272 English",
                "pdf_field_type": "Text",
                "reading_order": 30
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 415.32,
                    "r": 541.2,
                    "b": 395.6829
                },
                "text": "Newborn Hearing Screening: What to Expect (#5272S Spanish)",
                "reading_order": 31
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 378.96,
                    "t": 409.8,
                    "r": 462.72,
                    "b": 393.84
                },
                "text": "Quantity Requested_Newborn Hearing Screening: What to Expect (#5272S Spanish)",
                "field_kind": "text",
                "label": "Quantity Requested_Newborn Hearing Screening: What to Expect (#5272S Spanish)",
                "pdf_field_name": "Quantity RequestedNewborn Hearing Screening What to Expect 5272S Spanish",
                "pdf_field_type": "Text",
                "reading_order": 32
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 395.6829,
                    "r": 541.2,
                    "b": 376.0457
                },
                "text": "Parent Information: Newborn Hearing Screening (English)",
                "reading_order": 33
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 378.96,
                    "t": 392.64,
                    "r": 462.72,
                    "b": 376.68
                },
                "text": "Quantity Requested_Parent Information: Newborn Hearing Screening (English)",
                "field_kind": "text",
                "label": "Quantity Requested_Parent Information: Newborn Hearing Screening (English)",
                "pdf_field_name": "Quantity RequestedParent Information Newborn Hearing Screening English",
                "pdf_field_type": "Text",
                "reading_order": 34
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 376.0457,
                    "r": 541.2,
                    "b": 356.4086
                },
                "text": "Health Provider Information: Newborn Hearing Screening (English)",
                "reading_order": 35
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 378.96,
                    "t": 375.48,
                    "r": 462.72,
                    "b": 359.52
                },
                "text": "Quantity Requested_Health Provider Information: Newborn Hearing Screening (English)",
                "field_kind": "text",
                "label": "Quantity Requested_Health Provider Information: Newborn Hearing Screening (English)",
                "pdf_field_name": "Quantity RequestedHealth Provider Information Newborn Hearing Screening English",
                "pdf_field_type": "Text",
                "reading_order": 36
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 356.4086,
                    "r": 541.2,
                    "b": 336.7714
                },
                "text": "Take Notice & Take Action: Late Onset Hearing Loss (English)",
                "reading_order": 37
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 378.96,
                    "t": 358.32,
                    "r": 462.72,
                    "b": 342.48
                },
                "text": "Quantity Requested_Take Notice & Take Action: Late Onset Hearing Loss (English)",
                "field_kind": "text",
                "label": "Quantity Requested_Take Notice & Take Action: Late Onset Hearing Loss (English)",
                "pdf_field_name": "Quantity RequestedTake Notice  Take Action Late Onset Hearing Loss English",
                "pdf_field_type": "Text",
                "reading_order": 38
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 336.7714,
                    "r": 541.2,
                    "b": 317.1343
                },
                "text": "The Basics of Safe Sleep Card",
                "reading_order": 39
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 378.667,
                    "t": 341.736,
                    "r": 462.427,
                    "b": 325.896
                },
                "text": "Quantity Requested_Take Notice & Take Action: Late Onset Hearing Loss (English)",
                "field_kind": "text",
                "label": "Quantity Requested_Take Notice & Take Action: Late Onset Hearing Loss (English)",
                "pdf_field_name": "Quantity Requested_Basics of Sleep",
                "pdf_field_type": "Text",
                "reading_order": 40
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 238.5857,
                    "r": 541.2,
                    "b": 218.9486
                },
                "text": "Submit requests by mail: Submit requests by fax:",
                "reading_order": 41
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 218.9486,
                    "r": 541.2,
                    "b": 199.3114
                },
                "text": "Attn: Genetic Services 601-576-7498",
                "reading_order": 42
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 199.3114,
                    "r": 541.2,
                    "b": 179.6743
                },
                "text": "570 East Woodrow Wilson",
                "reading_order": 43
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 179.6743,
                    "r": 541.2,
                    "b": 160.0371
                },
                "text": "Post Office Box 1700",
                "reading_order": 44
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 160.0371,
                    "r": 541.2,
                    "b": 140.4
                },
                "text": "Jackson, MS 39215-1700 Submit requests by phone: 601-576-7619",
                "reading_order": 45
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.04,
                    "t": 111.12,
                    "r": 540.96,
                    "b": 93.6
                },
                "text": "Supplier Use Only",
                "reading_order": 46
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.04,
                    "t": 93.6,
                    "r": 540.96,
                    "b": 76.08
                },
                "text": "Filled by: Date:",
                "reading_order": 47
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 490.32,
                    "t": 60.72,
                    "r": 540.48,
                    "b": 48.96
                },
                "text": "Form 1308",
                "reading_order": 48
            }
        ]
    }
]