[
    {
        "page": 1,
        "items": [
            {
                "page": 1,
                "type": "TITLE",
                "location": {
                    "l": 227.52,
                    "t": 719.76,
                    "r": 384.96,
                    "b": 679.2
                },
                "text": "KENTUCKY STATE UNIVERSITY\nSCHOOL OF NURSING\nEMERGENCY CONTACT FORM",
                "reading_order": 0,
                "level": 1
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 69.84,
                    "t": 665.76,
                    "r": 134.88,
                    "b": 651.36
                },
                "text": "Please print",
                "reading_order": 1
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 70.8,
                    "t": 639.6,
                    "r": 282,
                    "b": 629.04
                },
                "text": "Student ID: ___",
                "reading_order": 2
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 72,
                    "t": 652.8,
                    "r": 281.04,
                    "b": 631.56
                },
                "text": "Full name (First, Middle, Last",
                "field_kind": "text",
                "label": "Full name (First, Middle, Last",
                "pdf_field_name": "Full name First Middle Last",
                "pdf_field_type": "Text",
                "reading_order": 3
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 69.6,
                    "t": 628.56,
                    "r": 223.68,
                    "b": 613.92
                },
                "text": "Full name (First, Middle, Last)",
                "reading_order": 4
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 321.6,
                    "t": 642.72,
                    "r": 516.24,
                    "b": 628.8
                },
                "text": "Student ID: ___",
                "reading_order": 5
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 387.84,
                    "t": 660.36,
                    "r": 514.56,
                    "b": 631.56
                },
                "text": "Student ID",
                "field_kind": "text",
                "label": "Student ID",
                "pdf_field_name": "Student ID",
                "pdf_field_type": "Text",
                "reading_order": 6
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 69.12,
                    "t": 591.36,
                    "r": 529.44,
                    "b": 549.6
                },
                "text": "Emergencies sometimes occur when you are in the clinical field. Please identify an individual that you authorize the School to contact in these situations and provide the requested information below.",
                "reading_order": 7
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 69.36,
                    "t": 537.12,
                    "r": 513.84,
                    "b": 495.84
                },
                "text": "Emergency situations may include instances where you must be removed from the academic setting (clinical or classroom) due to medical conditions and require transportation to a medical treatment facility.",
                "reading_order": 8
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 69.12,
                    "t": 483.6,
                    "r": 535.2,
                    "b": 457.68
                },
                "text": "Best practices dictate that you keep this information updated with the School and your clinical instructors.",
                "reading_order": 9
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 70.08,
                    "t": 457.68,
                    "r": 538.08,
                    "b": 446.16
                },
                "text": "*****",
                "reading_order": 10
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 72,
                    "t": 433.44,
                    "r": 390.84,
                    "b": 404.64
                },
                "text": "Full Name of Contact",
                "field_kind": "text",
                "label": "Full Name of Contact",
                "pdf_field_name": "Full Name of Contact",
                "pdf_field_type": "Text",
                "reading_order": 11
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 396.12,
                    "t": 433.44,
                    "r": 539.52,
                    "b": 404.64
                },
                "text": "Relationship to Student",
                "field_kind": "text",
                "label": "Relationship to Student",
                "pdf_field_name": "Relationship to Student",
                "pdf_field_type": "Text",
                "reading_order": 12
            },
            {
                "page": 1,
                "type": "TABLE",
                "location": {
                    "l": 67.92,
                    "t": 408,
                    "r": 540.96,
                    "b": 171.36
                },
                "text": "<table><tr><td>Full Name of Contact</td><td></td><td>Relationship to Student</td></tr><tr><td>Home Phone</td><td>Work Phone</td><td>Cell Phone</td></tr><tr><td>Street Address</td><td></td><td></td></tr><tr><td>City</td><td>State</td><td>Zip</td></tr><tr><td>Student Signature</td><td></td><td>Date</td></tr></table>",
                "rows": [
                    {
                        "row_index": 0,
                        "location": [
                            67.92,
                            360.672,
                            540.96,
                            408
                        ],
                        "cells": [
                            {
                                "location": [
                                    67.92,
                                    360.672,
                                    225.6,
                                    408
                                ],
                                "text": "Full Name of Contact",
                                "html_text": "Full Name of Contact",
                                "links": [],
                                "cell_header_index": 0,
                                "rowspan": 1,
                                "colspan": 1,
                                "column_header": false,
                                "row_header": true,
                                "placeholder": false,
                                "ref": "#/tables/0"
                            },
                            {
                                "location": [
                                    225.6,
                                    360.672,
                                    383.28,
                                    408
                                ],
                                "text": "",
                                "html_text": "",
                                "links": [],
                                "cell_header_index": 1,
                                "rowspan": 1,
                                "colspan": 1,
                                "column_header": false,
                                "row_header": false,
                                "placeholder": false,
                                "ref": "#/tables/0"
                            },
                            {
                                "location": [
                                    383.28,
                                    360.672,
                                    540.96,
                                    408
                                ],
                                "text": "Relationship to Student",
                                "html_text": "Relationship to Student",
                                "links": [],
                                "cell_header_index": 2,
                                "rowspan": 1,
                                "colspan": 1,
                                "column_header": false,
                                "row_header": false,
                                "placeholder": false,
                                "ref": "#/tables/0"
                            }
                        ],
                        "ref": "#/tables/0"
                    },
                    {
                        "row_index": 1,
                        "location": [
                            67.92,
                            313.344,
                            540.96,
                            360.672
                        ],
                        "cells": [
                            {
                                "location": [
                                    67.92,
                                    313.344,
                                    225.6,
                                    360.672
                                ],
                                "text": "Home Phone",
                                "html_text": "Home Phone",
                                "links": [],
                                "cell_header_index": 0,
                                "rowspan": 1,
                                "colspan": 1,
                                "column_header": false,
                                "row_header": true,
                                "placeholder": false,
                                "ref": "#/tables/0"
                            },
                            {
                                "location": [
                                    225.6,
                                    313.344,
                                    383.28,
                                    360.672
                                ],
                                "text": "Work Phone",
                                "html_text": "Work Phone",
                                "links": [],
                                "cell_header_index": 1,
                                "rowspan": 1,
                                "colspan": 1,
                                "column_header": false,
                                "row_header": false,
                                "placeholder": false,
                                "ref": "#/tables/0"
                            },
                            {
                                "location": [
                                    383.28,
                                    313.344,
                                    540.96,
                                    360.672
                                ],
                                "text": "Cell Phone",
                                "html_text": "Cell Phone",
                                "links": [],
                                "cell_header_index": 2,
                                "rowspan": 1,
                                "colspan": 1,
                                "column_header": false,
                                "row_header": false,
                                "placeholder": false,
                                "ref": "#/tables/0"
                            }
                        ],
                        "ref": "#/tables/0"
                    },
                    {
                        "row_index": 2,
                        "location": [
                            67.92,
                            266.016,
                            540.96,
                            313.344
                        ],
                        "cells": [
                            {
                                "location": [
                                    67.92,
                                    266.016,
                                    225.6,
                                    313.344
                                ],
                                "text": "Street Address",
                                "html_text": "Street Address",
                                "links": [],
                                "cell_header_index": 0,
                                "rowspan": 1,
                                "colspan": 1,
                                "column_header": false,
                                "row_header": true,
                                "placeholder": false,
                                "ref": "#/tables/0"
                            },
                            {
                                "location": [
                                    225.6,
                                    266.016,
                                    383.28,
                                    313.344
                                ],
                                "text": "",
                                "html_text": "",
                                "links": [],
                                "cell_header_index": 1,
                                "rowspan": 1,
                                "colspan": 1,
                                "column_header": false,
                                "row_header": false,
                                "placeholder": false,
                                "ref": "#/tables/0"
                            },
                            {
                                "location": [
                                    383.28,
                                    266.016,
                                    540.96,
                                    313.344
                                ],
                                "text": "",
                                "html_text": "",
                                "links": [],
                                "cell_header_index": 2,
                                "rowspan": 1,
                                "colspan": 1,
                                "column_header": false,
                                "row_header": false,
                                "placeholder": false,
                                "ref": "#/tables/0"
                            }
                        ],
                        "ref": "#/tables/0"
                    },
                    {
                        "row_index": 3,
                        "location": [
                            67.92,
                            218.688,
                            540.96,
                            266.016
                        ],
                        "cells": [
                            {
                                "location": [
                                    67.92,
                                    218.688,
                                    225.6,
                                    266.016
                                ],
                                "text": "City",
                                "html_text": "City",
                                "links": [],
                                "cell_header_index": 0,
                                "rowspan": 1,
                                "colspan": 1,
                                "column_header": false,
                                "row_header": true,
                                "placeholder": false,
                                "ref": "#/tables/0"
                            },
                            {
                                "location": [
                                    225.6,
                                    218.688,
                                    383.28,
                                    266.016
                                ],
                                "text": "State",
                                "html_text": "State",
                                "links": [],
                                "cell_header_index": 1,
                                "rowspan": 1,
                                "colspan": 1,
                                "column_header": false,
                                "row_header": false,
                                "placeholder": false,
                                "ref": "#/tables/0"
                            },
                            {
                                "location": [
                                    383.28,
                                    218.688,
                                    540.96,
                                    266.016
                                ],
                                "text": "Zip",
                                "html_text": "Zip",
                                "links": [],
                                "cell_header_index": 2,
                                "rowspan": 1,
                                "colspan": 1,
                                "column_header": false,
                                "row_header": false,
                                "placeholder": false,
                                "ref": "#/tables/0"
                            }
                        ],
                        "ref": "#/tables/0"
                    },
                    {
                        "row_index": 4,
                        "location": [
                            67.92,
                            171.36,
                            540.96,
                            218.688
                        ],
                        "cells": [
                            {
                                "location": [
                                    67.92,
                                    171.36,
                                    225.6,
                                    218.688
                                ],
                                "text": "Student Signature",
                                "html_text": "Student Signature",
                                "links": [],
                                "cell_header_index": 0,
                                "rowspan": 1,
                                "colspan": 1,
                                "column_header": false,
                                "row_header": true,
                                "placeholder": false,
                                "ref": "#/tables/0"
                            },
                            {
                                "location": [
                                    225.6,
                                    171.36,
                                    383.28,
                                    218.688
                                ],
                                "text": "",
                                "html_text": "",
                                "links": [],
                                "cell_header_index": 1,
                                "rowspan": 1,
                                "colspan": 1,
                                "column_header": false,
                                "row_header": false,
                                "placeholder": false,
                                "ref": "#/tables/0"
                            },
                            {
                                "location": [
                                    383.28,
                                    171.36,
                                    540.96,
                                    218.688
                                ],
                                "text": "Date",
                                "html_text": "Date",
                                "links": [],
                                "cell_header_index": 2,
                                "rowspan": 1,
                                "colspan": 1,
                                "column_header": false,
                                "row_header": false,
                                "placeholder": false,
                                "ref": "#/tables/0"
                            }
                        ],
                        "ref": "#/tables/0"
                    }
                ],
                "n_rows": 5,
                "n_cols": 3,
                "ref": "#/tables/0",
                "reading_order": 13
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 72,
                    "t": 379.32,
                    "r": 204,
                    "b": 350.52
                },
                "text": "Home Phone",
                "field_kind": "text",
                "label": "Home Phone",
                "pdf_field_name": "Home Phone",
                "pdf_field_type": "Text",
                "reading_order": 14
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 252,
                    "t": 379.32,
                    "r": 378.48,
                    "b": 350.52
                },
                "text": "Work Phone",
                "field_kind": "text",
                "label": "Work Phone",
                "pdf_field_name": "Work Phone",
                "pdf_field_type": "Text",
                "reading_order": 15
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 432.12,
                    "t": 379.32,
                    "r": 536.76,
                    "b": 350.52
                },
                "text": "Cell Phone",
                "field_kind": "text",
                "label": "Cell Phone",
                "pdf_field_name": "Cell Phone",
                "pdf_field_type": "Text",
                "reading_order": 16
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 72,
                    "t": 325.44,
                    "r": 539.52,
                    "b": 296.64
                },
                "text": "Street Address",
                "field_kind": "text",
                "label": "Street Address",
                "pdf_field_name": "Street Address",
                "pdf_field_type": "Text",
                "reading_order": 17
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 72,
                    "t": 271.44,
                    "r": 204,
                    "b": 242.64
                },
                "text": "City",
                "field_kind": "text",
                "label": "City",
                "pdf_field_name": "City",
                "pdf_field_type": "Text",
                "reading_order": 18
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 252,
                    "t": 271.44,
                    "r": 378.48,
                    "b": 242.64
                },
                "text": "State",
                "field_kind": "text",
                "label": "State",
                "pdf_field_name": "State",
                "pdf_field_type": "Text",
                "reading_order": 19
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 72,
                    "t": 217.56,
                    "r": 330.48,
                    "b": 188.76
                },
                "text": "Student Signature",
                "field_kind": "signature",
                "label": "Student Signature",
                "pdf_field_name": "Student Signature",
                "pdf_field_type": "Signature",
                "reading_order": 20
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 432.12,
                    "t": 271.44,
                    "r": 536.76,
                    "b": 242.64
                },
                "text": "Zip",
                "field_kind": "text",
                "label": "Zip",
                "pdf_field_name": "Zip",
                "pdf_field_type": "Text",
                "reading_order": 21
            },
            {
                "page": 1,
                "type": "FORM_FIELD",
                "location": {
                    "l": 396.12,
                    "t": 217.56,
                    "r": 539.16,
                    "b": 188.76
                },
                "text": "Date",
                "field_kind": "text",
                "label": "Date",
                "pdf_field_name": "Date",
                "pdf_field_type": "Text",
                "reading_order": 22
            }
        ]
    }
]