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fbRequireJSScript.addEventListener("load", conditionalSectionJs);var conditionalSectionJs = function () {\
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\
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\
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\
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\
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                } else {\
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                }\
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\
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\
            function encode(myString) {\
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\
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                    ];\
\
                for (i = 0; i < entities.length; i++) {\
                    myString = String(myString).replace(new RegExp(entities[i][0], \'g\'), entities[i][1]);\
                }\
\
                return myString;\
            }\
\
            function showHideSection(showSection) {\
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\
                $("#FormField30_2840db38-0f79-47a6-ae9a-6682771597a9 .conditionalSectionListSelection").each(function (i, obj) {\
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                            $(\'#\' + obj.id).change();\
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                    } else {\
                        $(\'#\' + obj.id).change();\
                    }\
                });\
            }\
        });\
    });\
};\
\
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<h1>Request a Lung Screening Appointment</h1><p>Please answer the following questions to determine if you qualify for lung cancer screening.</p><div class=\'form-group\'><label  class=\'control-label  \'>Are you 50 to 80 years old?<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'flow\'><input type=\'radio\' value=\'Yes\' required data-msg-required=\'Are you 50 to 80 years old? is required.\' name=\'checkbox20\' id=\'FormField20_2840db38-0f79-47a6-ae9a-6682771597a9_1\' class=\'right\' data-export-label=\'Are_you_50_to_80_years_old\' ><label for=\'FormField20_2840db38-0f79-47a6-ae9a-6682771597a9_1\'>Yes</label></div><div class=\'flow\'><input type=\'radio\' value=\'No\' required data-msg-required=\'Are you 50 to 80 years old? is required.\' name=\'checkbox20\' id=\'FormField20_2840db38-0f79-47a6-ae9a-6682771597a9_2\' class=\'right\' data-export-label=\'Are_you_50_to_80_years_old\' ><label for=\'FormField20_2840db38-0f79-47a6-ae9a-6682771597a9_2\'>No</label></div></fieldset></div></div></div><div class=\'fb-section\' style=\'display: none;\' id=\'FormField23_2840db38-0f79-47a6-ae9a-6682771597a9\'><div class=\'form-group\'><label  class=\'control-label  \'>Are you a current or former smoker?<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'flow\'><input type=\'radio\' value=\'Yes\' required data-msg-required=\'Are you a current or former smoker? is required.\' name=\'checkbox21\' id=\'FormField21_2840db38-0f79-47a6-ae9a-6682771597a9_1\' class=\'right\' data-export-label=\'Current_Smoker\' ><label for=\'FormField21_2840db38-0f79-47a6-ae9a-6682771597a9_1\'>Yes</label></div><div class=\'flow\'><input type=\'radio\' value=\'No\' required data-msg-required=\'Are you a current or former smoker? is required.\' name=\'checkbox21\' id=\'FormField21_2840db38-0f79-47a6-ae9a-6682771597a9_2\' class=\'right\' data-export-label=\'Current_Smoker\' ><label for=\'FormField21_2840db38-0f79-47a6-ae9a-6682771597a9_2\'>No</label></div></fieldset></div></div></div></div><div class=\'fb-section\' style=\'display: none;\' id=\'FormField26_2840db38-0f79-47a6-ae9a-6682771597a9\'><p>Thank you for your interest. Unfortunately you do not meet the criteria established by the United States Preventative Task Force of 50-80 years of age and are a current or former smoker. Please consult your primary provider for other options you may have.</p></div><div class=\'fb-section\' style=\'display: none;\' id=\'FormField28_2840db38-0f79-47a6-ae9a-6682771597a9\'><p>Thank you for your interest. Unfortunately you do not meet the criteria established by the United States Preventative Task Force of 50-80 years of age and are a current or former smoker. Please consult your primary provider for other options you may have.</p></div><div class=\'fb-section\' style=\'display: none;\' id=\'FormField30_2840db38-0f79-47a6-ae9a-6682771597a9\'><div class=\'form-group\'><label for=\'FormField1\' class=\'control-label  \'>First Name<span class=\'fb-required\'>*</span></label><div>\
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