[
    {
        "page": 1,
        "items": [
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 22.9153,
                    "t": 780.263,
                    "r": 94.9153,
                    "b": 760.263
                },
                "text": "Clear Form",
                "field_kind": "button",
                "label": "Clear Form",
                "pdf_field_name": "Button4",
                "pdf_field_type": "Button",
                "reading_order": 0
            },
            {
                "page": 1,
                "type": "TITLE",
                "location": {
                    "l": 173.76,
                    "t": 755.04,
                    "r": 438,
                    "b": 712.08
                },
                "text": "STATE OF ILLINOIS\nIN THE CIRCUIT COURT OF THE 17th JUDICIAL CIRCUIT COUNTY OF BOONE WINNEBAGO",
                "reading_order": 1,
                "level": 1
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 271.44,
                    "t": 722.64,
                    "r": 283.44,
                    "b": 714.6
                },
                "text": "BOONE",
                "field_kind": "checkbox",
                "label": "BOONE",
                "pdf_field_name": "BOONE",
                "pdf_field_type": "CheckBox",
                "reading_order": 2
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 324.96,
                    "t": 722.64,
                    "r": 336.96,
                    "b": 714.6
                },
                "text": "WINNEBAGO",
                "field_kind": "checkbox",
                "label": "WINNEBAGO",
                "pdf_field_name": "WINNEBAGO",
                "pdf_field_type": "CheckBox",
                "reading_order": 3
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 69.12,
                    "t": 695.04,
                    "r": 573.36,
                    "b": 574.56
                },
                "text": "FILE STAMP\nPETITIONER/PLAINTIFF,\nv.\nCase No.\nRESPONDENT/DEFENDANT.",
                "reading_order": 4
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 55.332,
                    "t": 687.484,
                    "r": 205.332,
                    "b": 665.484
                },
                "text": "PETITIONER/PLAINTIFF,",
                "field_kind": "text",
                "label": "PETITIONER/PLAINTIFF,",
                "pdf_field_name": "Text1",
                "pdf_field_type": "Text",
                "reading_order": 5
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 297.899,
                    "t": 640.536,
                    "r": 415.482,
                    "b": 618.536
                },
                "text": "Case No.",
                "field_kind": "text",
                "label": "Case No.",
                "pdf_field_name": "Text3",
                "pdf_field_type": "Text",
                "reading_order": 6
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 54.7731,
                    "t": 615.385,
                    "r": 204.773,
                    "b": 593.385
                },
                "text": "RESPONDENT/DEFENDANT. )",
                "field_kind": "text",
                "label": "RESPONDENT/DEFENDANT. )",
                "pdf_field_name": "Text2",
                "pdf_field_type": "Text",
                "reading_order": 7
            },
            {
                "page": 1,
                "type": "TITLE",
                "location": {
                    "l": 256.08,
                    "t": 563.52,
                    "r": 355.44,
                    "b": 550.8
                },
                "text": "MEDIATOR REPORT",
                "reading_order": 8,
                "level": 2
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 70.56,
                    "t": 540.96,
                    "r": 534,
                    "b": 527.28
                },
                "text": "☐I mediated with ___, and ___.",
                "reading_order": 9
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 363.48,
                    "t": 545.527,
                    "r": 530.64,
                    "b": 526.087
                },
                "text": "and",
                "field_kind": "text",
                "label": "and",
                "pdf_field_name": "and",
                "pdf_field_type": "Text",
                "reading_order": 10
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 164.678,
                    "t": 544.968,
                    "r": 337.838,
                    "b": 525.528
                },
                "text": "I mediated with",
                "field_kind": "text",
                "label": "I mediated with",
                "pdf_field_name": "I mediated with",
                "pdf_field_type": "Text",
                "reading_order": 11
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 72,
                    "t": 538.56,
                    "r": 84,
                    "b": 530.52
                },
                "text": "undefined",
                "field_kind": "checkbox",
                "label": "undefined",
                "pdf_field_name": "undefined",
                "pdf_field_type": "CheckBox",
                "reading_order": 12
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.28,
                    "t": 519.12,
                    "r": 532.56,
                    "b": 505.44
                },
                "text": "☐ I scheduled meetings on _____.",
                "reading_order": 13
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 205.2,
                    "t": 523.488,
                    "r": 527.76,
                    "b": 504.048
                },
                "text": "I scheduled meetings on",
                "field_kind": "text",
                "label": "I scheduled meetings on",
                "pdf_field_name": "I scheduled meetings on",
                "pdf_field_type": "Text",
                "reading_order": 14
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 72,
                    "t": 517.08,
                    "r": 84,
                    "b": 509.04
                },
                "text": "undefined",
                "field_kind": "checkbox",
                "label": "undefined",
                "pdf_field_name": "undefined_2",
                "pdf_field_type": "CheckBox",
                "reading_order": 15
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 105.84,
                    "t": 498.24,
                    "r": 540.48,
                    "b": 483.6
                },
                "text": "□I met with them on _____ for a total time of _____. (00.00)",
                "reading_order": 16
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 215.242,
                    "t": 501.888,
                    "r": 310.762,
                    "b": 482.448
                },
                "text": "I met with them on",
                "field_kind": "text",
                "label": "I met with them on",
                "pdf_field_name": "I met with them on",
                "pdf_field_type": "Text",
                "reading_order": 17
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 403.639,
                    "t": 501.329,
                    "r": 499.159,
                    "b": 481.889
                },
                "text": "for a total time of",
                "field_kind": "text",
                "label": "for a total time of",
                "pdf_field_name": "for a total time of",
                "pdf_field_type": "Text",
                "reading_order": 18
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 108.559,
                    "t": 495.48,
                    "r": 120,
                    "b": 487.44
                },
                "text": "undefined",
                "field_kind": "checkbox",
                "label": "undefined",
                "pdf_field_name": "undefined_3",
                "pdf_field_type": "CheckBox",
                "reading_order": 19
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.04,
                    "t": 477.6,
                    "r": 540,
                    "b": 446.16
                },
                "text": "□Prior to and during mediation, I screened the case for eligibility pursuant to Local Rule 14.08 Rule 6 on safety protocols, and determined that the matter □ was □ was not eligible.",
                "reading_order": 20
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 108,
                    "t": 474,
                    "r": 120,
                    "b": 465.96
                },
                "text": "Prior to and during mediation, I screened the case for eligibility pursuant to Local Rule",
                "field_kind": "checkbox",
                "label": "Prior to and during mediation, I screened the case for eligibility pursuant to Local Rule",
                "pdf_field_name": "Prior to and during mediation I screened the case for eligibility pursuant to Local Rule",
                "pdf_field_type": "CheckBox",
                "reading_order": 21
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 394.399,
                    "t": 458.4,
                    "r": 405.84,
                    "b": 450.36
                },
                "text": "was",
                "field_kind": "checkbox",
                "label": "was",
                "pdf_field_name": "was",
                "pdf_field_type": "CheckBox",
                "reading_order": 22
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 430.2,
                    "t": 458.4,
                    "r": 442.2,
                    "b": 450.36
                },
                "text": "was not eligible",
                "field_kind": "checkbox",
                "label": "was not eligible",
                "pdf_field_name": "was not eligible",
                "pdf_field_type": "CheckBox",
                "reading_order": 23
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 105.6,
                    "t": 439.44,
                    "r": 527.76,
                    "b": 425.28
                },
                "text": "□No mediation occurred because a prior agreement resolving all issues was reached.",
                "reading_order": 24
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 108,
                    "t": 436.8,
                    "r": 120,
                    "b": 428.76
                },
                "text": "No mediation occurred because a prior agreement resolving all issues was reached",
                "field_kind": "checkbox",
                "label": "No mediation occurred because a prior agreement resolving all issues was reached",
                "pdf_field_name": "No mediation occurred because a prior agreement resolving all issues was reached",
                "pdf_field_type": "CheckBox",
                "reading_order": 25
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 69.12,
                    "t": 417.6,
                    "r": 524.88,
                    "b": 388.08
                },
                "text": "□No mediation occurred because _____ failed to: □ contact the mediator to schedule mediation □ appear for a scheduled mediation □ pay the mediator.",
                "reading_order": 26
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 278.719,
                    "t": 421.169,
                    "r": 404.239,
                    "b": 401.729
                },
                "text": "No mediation occurred because",
                "field_kind": "text",
                "label": "No mediation occurred because",
                "pdf_field_name": "No mediation occurred because",
                "pdf_field_type": "Text",
                "reading_order": 27
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 108,
                    "t": 415.32,
                    "r": 120,
                    "b": 407.28
                },
                "text": "mediator to schedule mediation",
                "field_kind": "checkbox",
                "label": "mediator to schedule mediation",
                "pdf_field_name": "mediator to schedule mediation",
                "pdf_field_type": "CheckBox",
                "reading_order": 28
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 453,
                    "t": 415.32,
                    "r": 465,
                    "b": 407.28
                },
                "text": "contact the",
                "field_kind": "checkbox",
                "label": "contact the",
                "pdf_field_name": "contact the",
                "pdf_field_type": "CheckBox",
                "reading_order": 29
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 231.36,
                    "t": 399.72,
                    "r": 243.36,
                    "b": 391.68
                },
                "text": "appear for a scheduled mediation",
                "field_kind": "checkbox",
                "label": "appear for a scheduled mediation",
                "pdf_field_name": "appear for a scheduled mediation",
                "pdf_field_type": "CheckBox",
                "reading_order": 30
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 413.4,
                    "t": 399.72,
                    "r": 425.4,
                    "b": 391.68
                },
                "text": "pay the mediator",
                "field_kind": "checkbox",
                "label": "pay the mediator",
                "pdf_field_name": "pay the mediator",
                "pdf_field_type": "CheckBox",
                "reading_order": 31
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.28,
                    "t": 379.44,
                    "r": 525.84,
                    "b": 351.36
                },
                "text": "□One or both the parties has/have not completed the parent education program as required by Local Rule 14.08(2)(B).",
                "reading_order": 32
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 111.24,
                    "t": 377.52,
                    "r": 123.24,
                    "b": 369.48
                },
                "text": "One or both the parties has/have not completed the parent education program as",
                "field_kind": "checkbox",
                "label": "One or both the parties has/have not completed the parent education program as",
                "pdf_field_name": "One or both the parties hashave not completed the parent education program as",
                "pdf_field_type": "CheckBox",
                "reading_order": 33
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 71.76,
                    "t": 349.68,
                    "r": 548.16,
                    "b": 321.12
                },
                "text": "□ No mediation occurred because one or both parties has indicated a change in financial circumstances since ordered to mediation, and the case is being sent to court for clarification",
                "reading_order": 34
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 111.24,
                    "t": 347.28,
                    "r": 123.24,
                    "b": 339.24
                },
                "text": "No mediation occurred because one or both parties has indicated a change in financial",
                "field_kind": "checkbox",
                "label": "No mediation occurred because one or both parties has indicated a change in financial",
                "pdf_field_name": "No mediation occurred because one or both parties has indicated a change in financial",
                "pdf_field_type": "CheckBox",
                "reading_order": 35
            },
            {
                "page": 1,
                "type": "LIST_ITEM",
                "location": {
                    "l": 104.88,
                    "t": 316.08,
                    "r": 341.28,
                    "b": 302.88
                },
                "text": "A. The mediation has now concluded because:",
                "marker": "A.",
                "list_id": "L1",
                "level": 0,
                "reading_order": 36
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 141.6,
                    "t": 294.96,
                    "r": 471.36,
                    "b": 280.8
                },
                "text": "☐The parties have reached an agreement as to all disputed issues.",
                "reading_order": 37
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 144,
                    "t": 292.56,
                    "r": 156,
                    "b": 284.52
                },
                "text": "The parties have reached an agreement as to all disputed issues",
                "field_kind": "checkbox",
                "label": "The parties have reached an agreement as to all disputed issues",
                "pdf_field_name": "The parties have reached an agreement as to all disputed issues",
                "pdf_field_type": "CheckBox",
                "reading_order": 38
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 122.88,
                    "t": 273.36,
                    "r": 537.36,
                    "b": 244.56
                },
                "text": "□The parties have reached an agreement as to some of the issues and are at an impasse in regard to the remaining issues.",
                "reading_order": 39
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 144,
                    "t": 271.08,
                    "r": 156,
                    "b": 263.04
                },
                "text": "The parties have reached an agreement as to some of the issues and are at an",
                "field_kind": "checkbox",
                "label": "The parties have reached an agreement as to some of the issues and are at an",
                "pdf_field_name": "The parties have reached an agreement as to some of the issues and are at an",
                "pdf_field_type": "CheckBox",
                "reading_order": 40
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 141.36,
                    "t": 237.12,
                    "r": 523.92,
                    "b": 223.44
                },
                "text": "Pursuant to local rule, the mediation has been terminated by the mediator.",
                "reading_order": 41
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 144,
                    "t": 234.84,
                    "r": 156,
                    "b": 226.8
                },
                "text": "Pursuant to local rule, the mediation has been terminated by the mediator",
                "field_kind": "checkbox",
                "label": "Pursuant to local rule, the mediation has been terminated by the mediator",
                "pdf_field_name": "Pursuant to local rule the mediation has been terminated by the mediator",
                "pdf_field_type": "CheckBox",
                "reading_order": 42
            },
            {
                "page": 1,
                "type": "LIST_ITEM",
                "location": {
                    "l": 105.36,
                    "t": 215.76,
                    "r": 513.6,
                    "b": 186.96
                },
                "text": "B. The appointment of a Child Representative or Guardian ad Litem □ is □ is not recommended in accordance with Local Rule 14.08(8)(H).",
                "marker": "B.",
                "list_id": "L2",
                "level": 0,
                "reading_order": 43
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 444.12,
                    "t": 213.24,
                    "r": 456.12,
                    "b": 205.2
                },
                "text": "is",
                "field_kind": "checkbox",
                "label": "is",
                "pdf_field_name": "is",
                "pdf_field_type": "CheckBox",
                "reading_order": 44
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 468.96,
                    "t": 213.24,
                    "r": 480.96,
                    "b": 205.2
                },
                "text": "is not",
                "field_kind": "checkbox",
                "label": "is not",
                "pdf_field_name": "is not",
                "pdf_field_type": "CheckBox",
                "reading_order": 45
            },
            {
                "page": 1,
                "type": "LIST_ITEM",
                "location": {
                    "l": 104.64,
                    "t": 179.52,
                    "r": 530.88,
                    "b": 135.6
                },
                "text": "C. □Mediation continues with the next session scheduled on _____ and it is anticipated that an additional _____ days will be needed to complete the process.",
                "marker": "C.",
                "list_id": "L3",
                "level": 0,
                "reading_order": 46
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 416.198,
                    "t": 183.967,
                    "r": 564.25,
                    "b": 164.527
                },
                "text": "Mediation continues with the next session scheduled on",
                "field_kind": "text",
                "label": "Mediation continues with the next session scheduled on",
                "pdf_field_name": "Mediation continues with the next session scheduled on",
                "pdf_field_type": "Text",
                "reading_order": 47
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 126,
                    "t": 177,
                    "r": 138,
                    "b": 168.96
                },
                "text": "C",
                "field_kind": "checkbox",
                "label": "C",
                "pdf_field_name": "C",
                "pdf_field_type": "CheckBox",
                "reading_order": 48
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 313.8,
                    "t": 164.324,
                    "r": 349.56,
                    "b": 150.764
                },
                "text": "and it is anticipated that an additional",
                "field_kind": "text",
                "label": "and it is anticipated that an additional",
                "pdf_field_name": "and it is anticipated that an additional",
                "pdf_field_type": "Text",
                "reading_order": 49
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 69.6,
                    "t": 114.72,
                    "r": 217.68,
                    "b": 101.76
                },
                "text": "DATE:___",
                "reading_order": 50
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 101.4,
                    "t": 123.6,
                    "r": 216.12,
                    "b": 104.16
                },
                "text": "DATE",
                "field_kind": "text",
                "label": "DATE",
                "pdf_field_name": "DATE",
                "pdf_field_type": "Text",
                "reading_order": 51
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 69.36,
                    "t": 94.8,
                    "r": 305.04,
                    "b": 81.36
                },
                "text": "NAME:___",
                "reading_order": 52
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 106.2,
                    "t": 103.2,
                    "r": 303.24,
                    "b": 83.76
                },
                "text": "NAME",
                "field_kind": "text",
                "label": "NAME",
                "pdf_field_name": "NAME",
                "pdf_field_type": "Text",
                "reading_order": 53
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 69.6,
                    "t": 74.64,
                    "r": 307.2,
                    "b": 60.72
                },
                "text": "ADDRESS:___\nSIGNED:___",
                "reading_order": 54
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 120.48,
                    "t": 82.56,
                    "r": 305.52,
                    "b": 63.12
                },
                "text": "ADDRESS",
                "field_kind": "text",
                "label": "ADDRESS",
                "pdf_field_name": "ADDRESS",
                "pdf_field_type": "Text",
                "reading_order": 55
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 69.6,
                    "t": 54.24,
                    "r": 308.88,
                    "b": 40.32
                },
                "text": "PHONE:___",
                "reading_order": 56
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 110.52,
                    "t": 61.8,
                    "r": 307.68,
                    "b": 42.48
                },
                "text": "PHONE",
                "field_kind": "text",
                "label": "PHONE",
                "pdf_field_name": "PHONE",
                "pdf_field_type": "Text",
                "reading_order": 57
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 321.6,
                    "t": 115.2,
                    "r": 527.04,
                    "b": 101.76
                },
                "text": "SIGNED:",
                "reading_order": 58
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 364.44,
                    "t": 123.84,
                    "r": 525.6,
                    "b": 104.4
                },
                "text": "SIGNED",
                "field_kind": "text",
                "label": "SIGNED",
                "pdf_field_name": "SIGNED",
                "pdf_field_type": "Text",
                "reading_order": 59
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 524.16,
                    "t": 30.24,
                    "r": 538.32,
                    "b": 19.2
                },
                "text": "BB",
                "reading_order": 60
            }
        ]
    }
]