{"id":24876,"date":"2024-02-05T09:47:23","date_gmt":"2024-02-05T09:47:23","guid":{"rendered":"https:\/\/ameripharmaspecialty.com\/?page_id=24876"},"modified":"2024-09-03T16:21:39","modified_gmt":"2024-09-03T23:21:39","slug":"copay-form","status":"publish","type":"page","link":"https:\/\/ameripharmaspecialty.com\/zh\/copay-form\/","title":{"rendered":"\u5171\u540c\u4ed8\u6b3e\u8868\u683c"},"content":{"rendered":"<div id=\"form\">\n\t<div  id=\"blog-form-25c24a439f808e3bf78412f2390bb4ec\" style=\"\" class=\"blogForm image\">\n\t\t<div class=\"container\">\n\n\t\t\t\t\t\t\t<h2 class=\"title\">Copay Assistance Application<\/h2>\n\t\t\t\n\t\t\t\t\t\t\t<div class=\"text\"><p>Fill out the HIPAA-compliant form below so we can help you locate all available funding sources and match you to top-dollar foundation programs<\/p>\n<\/div>\n\t\t\t\n\t\t\t<div class=\"form\">\n\t\t\t\t\t<div id=\"iframe-container\"><\/div>\n\t\t\t\t\t<script>     \n                        window.addEventListener('DOMContentLoaded', () => {\n                            function buildForm(posthogID) {\n                                let formId = \"Lac86iCjiIyfdFLJylVF\";\n                                let formHeight = '400px';\n                                function getURLParameter(e){return decodeURIComponent((RegExp(e+\"=(.+?)(&|$)\").exec(location.search)||[,null])[1])}   \n                                let utmParams = ['utm_source','utm_medium','utm_campaign','utm_campaignid','utm_adgroup','utm_term','utm_keyword','keyword','device','match','loc','utm_network','gclid','extensionid', 'sitelink'];   \n                                let formUrl = 'https:\/\/api.leadconnectorhq.com\/widget\/survey\/';   \n                                let formJs = 'https:\/\/msgsndr.com\/js\/form_embed.js';   \n                                let urlParams = '?'; \n\n                                for (let param of utmParams) {     \n                                    getURLParameter();     \n                                    let urlTerm = getURLParameter(param);     \n                                    if (urlTerm.trim().length > 0 && urlTerm != \"null\") {       \n                                            urlParams += `${param}=${decodeURIComponent(urlTerm).replace(\/\\+\/g,' ')}&`;     \n                                    }   \n                                }   \n\n                                let cleanURL = window.location.origin + window.location.pathname;   \n                                let ifrm = document.createElement('iframe');   \n                                ifrm.setAttribute('id', \"ct-form\");   \n                                ifrm.setAttribute('title', 'Form');\n                                ifrm.setAttribute('src', formUrl + formId + urlParams + \"&pID=\" + posthogID + \"&page_url=\" + cleanURL);   \n                                ifrm.setAttribute('scrolling', 'no');   \n                                ifrm.setAttribute('style', 'border:none;width:100%;min-height:unset;height:' + formHeight);   \n                                let s = document.createElement('script');   \n                                s.type = 'text\/javascript';   \n                                s.src = formJs;   \n                                var el = document.getElementById('iframe-container');   \n                                el.appendChild(ifrm, el);   \n                                el.appendChild(s, el); \n                            }\n\n                            function tryPosthogThenBuild() {\n                                if (typeof posthog !== 'undefined' && typeof posthog.onLoaded === 'function') {\n                                    \/\/ \u2705 Best case: wait for PostHog's ready event\n                                    posthog.onLoaded(() => {\n                                        const id = posthog.get_distinct_id();\n                                        buildForm(id);\n                                    });\n                                } else {\n                                    \/\/ Poll every 500ms until PostHog gives a valid ID\n                                    let attempts = 0;\n                                    const maxAttempts = 10; \/\/ ~5 seconds at 500ms each\n                                    const interval = setInterval(() => {\n                                        attempts++;\n                                        if (typeof posthog !== 'undefined' && typeof posthog.get_distinct_id === 'function') {\n                                            const id = posthog.get_distinct_id();\n                                            if (id && id.trim().length > 0) {\n                                                buildForm(id);        \/\/ \u2705 Build with real ID\n                                                clearInterval(interval);\n                                                return;\n                                            }\n                                        }\n                                        \/\/ If max attempts reached, give up and build with null\n                                        if (attempts >= maxAttempts) {\n                                            buildForm(null);        \/\/ \u2705 Fallback with no ID\n                                            clearInterval(interval);\n                                        }\n                                    }, 500);\n                                }\n                            }\n\n                            tryPosthogThenBuild();\n\n                        });\n                    <\/script>\n                    <p style=\"text-align: center;\"><img decoding=\"async\" src=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2024\/07\/hipaa_logo.png\" width=\"160\" alt=\"HIPAA Compliant\" \/><\/p>\n                    \t\t\t\t<p style=\"text-align: center;\" class=\"legal-block\">By submitting, you agree to AmeriPharma\u2019s <a href=\"https:\/\/ameripharmaspecialty.com\/terms-of-use\/\" target=\"_blank\" rel=\"noopener\">Terms of Use<\/a>, <a href=\"https:\/\/ameripharmaspecialty.com\/privacy-policy\/\" target=\"_blank\" rel=\"noopener\">Privacy Policy<\/a>, and <a href=\"https:\/\/ameripharmaspecialty.com\/notice-of-privacy-practices\/\" target=\"_blank\" rel=\"noopener\">Notice of Privacy Practices<\/a><\/p>\n\n\t\t\t\t<\/div>\n\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n<div  id=\"call-to-action-4176cbab4c498560d1f321da30a215f8\" style=\"\" class=\"ct_call_to_action\">\n\t<div class=\"container\">\n\t\t<div class=\"block-wrap cta\">\n\t\t\t<div class=\"block-column\">\n\t\t\t\t<div class=\"cta_headings\">\n\t\t\t\t\t\t\t\t\t\t\t<h4 class=\"cta__heading\">\n\t\t\t\t\t\t\tSpeak with a Copay Assistance Specialist\t\t\t\t\t\t<\/h4>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"cta__sub__heading\">\n\t\t\t\t\t\t\tOur team of copay assistance experts assists with every step of the application process\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<span class=\"cta_btn\">\n\t\t\t\t\t\t<a href=\"tel:8777780318\">(877) 778-0318<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t<\/div>\n\t<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":true,"om_disable_all_campaigns":false,"_uag_custom_page_level_css":"","footnotes":""},"categories":[],"tags":[],"class_list":["post-24876","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Copay Assistance | Specialty Care | AmeriPharma Specialty<\/title>\n<meta name=\"description\" content=\"AmeriPharma Specialty assists patients through a network of financial foundations. 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