{"id":15916,"date":"2024-02-14T11:50:24","date_gmt":"2024-02-14T17:50:24","guid":{"rendered":"https:\/\/bouncetozero.com\/agency-intake\/"},"modified":"2025-12-10T05:22:09","modified_gmt":"2025-12-10T11:22:09","slug":"agency-intake","status":"publish","type":"page","link":"https:\/\/bouncetozero.com\/vi\/agency-intake\/","title":{"rendered":"Danh s\u00e1ch C\u01a1 quan"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"15916\" class=\"elementor elementor-15916 elementor-12713\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b2bd1af elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b2bd1af\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-53102e5\" data-id=\"53102e5\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-31ccc9a elementor-widget elementor-widget-heading\" data-id=\"31ccc9a\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">M\u1eabu \u0110\u0103ng k\u00fd Tham gia<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3b675ab elementor-widget elementor-widget-heading\" data-id=\"3b675ab\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\"><span class=\"c-highlight c-highlight--title-yellow\">Danh s\u00e1ch C\u01a1 quan<\/span><\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a06a445 elementor-widget elementor-widget-heading\" data-id=\"a06a445\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">c\u1ee7a Ch\u00fang t\u00f4i<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-472b029 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"472b029\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-d1c0ed8\" data-id=\"d1c0ed8\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-e1a574e elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e1a574e\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-b52b690\" data-id=\"b52b690\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-74c9a6c elementor-widget elementor-widget-shortcode\" data-id=\"74c9a6c\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework agency-intake-form-required-field_wrapper' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_6' >\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">C\u01a1 quan Ti\u1ebfp nh\u1eadn<\/h2>\n                            <p class='gform_description'>Vui l\u00f2ng \u0111i\u1ec1n th\u00f4ng tin s\u1ef1 ki\u1ec7n c\u1ee7a qu\u00fd v\u1ecb. H\u00e3y nh\u1edb theo d\u00f5i\/th\u00edch @bouncetozero tr\u00ean m\u1ea1ng x\u00e3 h\u1ed9i (Instagram, Facebook v\u00e0\/ho\u1eb7c X) \u0111\u1ec3 c\u00f3 c\u01a1 h\u1ed9i \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u.  <\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_custom\">B\u1eaeT BU\u1ed8C*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_6' class='agency-intake-form-required-field' action='\/vi\/wp-json\/wp\/v2\/pages\/15916' data-formid='6' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_6' class='gform_fields top_label form_sublabel_below description_above validation_below'><div class=\"gfmc-container\"><div class=\"gfield gfmc-column gfmc-field\"><div id=\"field_6_3\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_3'>T\u00ean c\u01a1 quan\/ph\u00f2ng kh\u00e1m<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_custom\">B\u1eaeT BU\u1ed8C*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_6_3' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_7\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_7'>S\u1ed1 \u0110i\u1ec7n tho\u1ea1i<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_custom\">B\u1eaeT BU\u1ed8C*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_7' id='input_6_7' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_6\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_6'>\u0110\u1ecba ch\u1ec9 Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_custom\">B\u1eaeT BU\u1ed8C*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_6' id='input_6_6' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><\/div><div class=\"gfield gfmc-column gfmc-field\"><fieldset id=\"field_6_42\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full agency-intake-adress gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u0110i\u0323a chi\u0309<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_custom\">B\u1eaeT BU\u1ed8C*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_6_42' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_6_42_1_container' >\n                                        <input type='text' name='input_42.1' id='input_6_42_1' value=''   placeholder='\u0110\u01b0\u1eddng ph\u1ed1' aria-required='true'    \/>\n                                        <label for='input_6_42_1' id='input_6_42_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_6_42_3_container' >\n                                    <input type='text' name='input_42.3' id='input_6_42_3' value=''   placeholder='Th\u00e0nh ph\u1ed1' aria-required='true'    \/>\n                                    <label for='input_6_42_3' id='input_6_42_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_6_42_4_container' >\n                                        <input type='text' name='input_42.4' id='input_6_42_4' value=''     placeholder='Ti\u1ec3u bang' aria-required='true'    \/>\n                                        <label for='input_6_42_4' id='input_6_42_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_6_42_5_container' >\n                                    <input type='text' name='input_42.5' id='input_6_42_5' value=''   placeholder='S\u1ed1 ZIP' aria-required='true'    \/>\n                                    <label for='input_6_42_5' id='input_6_42_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_42.6' id='input_6_42_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_6_9\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full agency-intake-website-field gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_9'>Trang web<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_custom\">B\u1eaeT BU\u1ed8C*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_6_9' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div><\/div><div class=\"gfmc-container\"><div class=\"gfield gfmc-column gfmc-field\"><fieldset id=\"field_6_38\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-seven-twelfths services-container-left field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >C\u00e1c D\u1ecbch v\u1ee5 \u0110\u01b0\u1ee3c cung c\u1ea5p<\/legend><div class='gfield_description' id='gfield_description_6_38'>Vui l\u00f2ng ch\u1ecdn t\u1ea5t c\u1ea3 c\u00e1c d\u1ecbch v\u1ee5 m\u00e0 qu\u00fd v\u1ecb cung c\u1ea5p t\u1eeb danh s\u00e1ch d\u01b0\u1edbi \u0111\u00e2y.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_6_38'><div class='gchoice gchoice_6_38_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.1' type='checkbox'  value='X\u00e9t nghi\u1ec7m HIV'  id='choice_6_38_1'   aria-describedby=\"gfield_description_6_38\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_6_38_1' id='label_6_38_1' class='gform-field-label gform-field-label--type-inline'>X\u00e9t nghi\u1ec7m HIV<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_38_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.2' type='checkbox'  value='X\u00e9t nghi\u1ec7m STI'  id='choice_6_38_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_38_2' id='label_6_38_2' class='gform-field-label gform-field-label--type-inline'>X\u00e9t nghi\u1ec7m STI<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_38_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.3' type='checkbox'  value='Counseling &lt;\/br&gt;&lt;span class=&quot;services counseling&quot;&gt;Provides individual and group support and counseling. &lt;\/span&gt; '  id='choice_6_38_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_38_3' id='label_6_38_3' class='gform-field-label gform-field-label--type-inline'>T\u01b0 v\u1ea5n <\/br><span class=\"services counseling\">Cung c\u1ea5p h\u1ed7 tr\u1ee3 v\u00e0 t\u01b0 v\u1ea5n c\u00e1 nh\u00e2n v\u00e0 theo nh\u00f3m.<\/span> <\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_38_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.4' type='checkbox'  value='Emergency Financial Assistance &lt;\/br&gt;&lt;span class=&quot;services&quot;&gt;Assists clients with essential utilities and basic telephone, critical need items, emergency medications and short-term housing assistance.&lt;\/span&gt;'  id='choice_6_38_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_38_4' id='label_6_38_4' class='gform-field-label gform-field-label--type-inline'>H\u1ed7 tr\u1ee3 T\u00e0i ch\u00ednh Kh\u1ea9n c\u1ea5p <\/br><span class=\"services\">H\u1ed7 tr\u1ee3 kh\u00e1ch h\u00e0ng v\u1edbi c\u00e1c d\u1ecbch v\u1ee5 ti\u1ec7n \u00edch thi\u1ebft y\u1ebfu, \u0111i\u1ec7n tho\u1ea1i c\u01a1 b\u1ea3n, c\u00e1c v\u1eadt d\u1ee5ng c\u1ea7n thi\u1ebft, thu\u1ed1c kh\u1ea9n c\u1ea5p v\u00e0 h\u1ed7 tr\u1ee3 nh\u00e0 \u1edf t\u1ea1m th\u1eddi.<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_38_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.5' type='checkbox'  value='Food Bank &lt;\/br&gt;&lt;span class=&quot;services&quot;&gt;Provides food, food vouchers and personal care items to help with taking medications.&lt;\/span&gt;'  id='choice_6_38_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_38_5' id='label_6_38_5' class='gform-field-label gform-field-label--type-inline'>Ng\u00e2n h\u00e0ng Th\u1ef1c ph\u1ea9m<\/br><span class=\"services\">Cung c\u1ea5p th\u1ef1c ph\u1ea9m, phi\u1ebfu th\u1ef1c ph\u1ea9m v\u00e0 c\u00e1c v\u1eadt d\u1ee5ng ch\u0103m s\u00f3c c\u00e1 nh\u00e2n \u0111\u1ec3 gi\u00fap vi\u1ec7c d\u00f9ng thu\u1ed1c.<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_38_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.6' type='checkbox'  value='Health Insurance Assistance &lt;\/br&gt;&lt;span class=&quot;services&quot;&gt;Provides assistance with insurance premiums, co-pays and deductibles for medications, outpatient primary medical care, dental and vision for clients.&lt;\/span&gt;'  id='choice_6_38_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_38_6' id='label_6_38_6' class='gform-field-label gform-field-label--type-inline'>Ng\u00e2n h\u00e0ng Th\u1ef1c ph\u1ea9m <\/br><span class=\"services\">Cung c\u1ea5p th\u1ef1c ph\u1ea9m, phi\u1ebfu th\u1ef1c ph\u1ea9m v\u00e0 c\u00e1c v\u1eadt d\u1ee5ng ch\u0103m s\u00f3c c\u00e1 nh\u00e2n \u0111\u1ec3 gi\u00fap vi\u1ec7c d\u00f9ng thu\u1ed1c.<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_38_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.7' type='checkbox'  value='Home Delivered Meals &lt;\/br&gt;&lt;span class=&quot;services&quot;&gt;Provides readymade meals to clients who are homebound.&lt;\/span&gt;'  id='choice_6_38_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_38_7' id='label_6_38_7' class='gform-field-label gform-field-label--type-inline'>B\u1eefa \u0103n Giao T\u1eadn nh\u00e0 <\/br><span class=\"services\">Cung c\u1ea5p b\u1eefa \u0103n ch\u1ebf bi\u1ebfn s\u1eb5n cho nh\u1eefng kh\u00e1ch h\u00e0ng kh\u00f4ng th\u1ec3 ra kh\u1ecfi nh\u00e0.<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_38_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.8' type='checkbox'  value='Non-Medical Case Management &lt;\/br&gt;&lt;span class=&quot;services&quot;&gt;Provides advice and assistance to empower clients to access a variety of necessary services (including medical, social, community, legal and financial).&lt;\/span&gt;'  id='choice_6_38_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_38_8' id='label_6_38_8' class='gform-field-label gform-field-label--type-inline'>Qu\u1ea3n l\u00fd H\u1ed3 s\u01a1 Phi y t\u1ebf <\/br><span class=\"services\">T\u01b0 v\u1ea5n v\u00e0 h\u1ed7 tr\u1ee3 \u0111\u1ec3 kh\u00e1ch h\u00e0ng ti\u1ebfp c\u1eadn c\u00e1c d\u1ecbch v\u1ee5 c\u1ea7n thi\u1ebft (bao g\u1ed3m y t\u1ebf, x\u00e3 h\u1ed9i, c\u1ed9ng \u0111\u1ed3ng, ph\u00e1p l\u00fd v\u00e0 t\u00e0i ch\u00ednh).<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div><div class=\"gfield gfmc-column gfmc-field\"><fieldset id=\"field_6_41\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full services-container-right field_sublabel_below gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >C\u00e1c D\u1ecbch v\u1ee5 \u0110\u01b0\u1ee3c cung c\u1ea5p<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_6_41'><div class='gchoice gchoice_6_41_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.1' type='checkbox'  value='Housing Assistance&lt;\/br&gt;&lt;span class=&quot;services&quot;&gt;Provides rental assistance up to 12 months per client in a grant year, excluding emergency\/transitional housing assistance providers.&lt;\/span&gt;'  id='choice_6_41_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_41_1' id='label_6_41_1' class='gform-field-label gform-field-label--type-inline'>H\u1ed7 tr\u1ee3 Ti\u1ec1n thu\u00ea nh\u00e0 <\/br><span class=\"services\">H\u1ed7 tr\u1ee3 ti\u1ec1n thu\u00ea nh\u00e0 t\u1ed1i \u0111a 12 th\u00e1ng cho m\u1ed7i kh\u00e1ch h\u00e0ng trong m\u1ed9t n\u0103m t\u00e0i tr\u1ee3, kh\u00f4ng bao g\u1ed3m c\u00e1c \u0111\u01a1n v\u1ecb h\u1ed7 tr\u1ee3 nh\u00e0 \u1edf kh\u1ea9n c\u1ea5p\/t\u1ea1m th\u1eddi<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_41_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.2' type='checkbox'  value='Legal &lt;\/br&gt;&lt;span class=&quot;services&quot;&gt;Assists clients with legal matters such as documents relating to personal and estate planning, discriminations, notarial services, debtor problems or apply for public benefits (SSI, unemployment).&lt;\/span&gt;'  id='choice_6_41_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_41_2' id='label_6_41_2' class='gform-field-label gform-field-label--type-inline'>Ph\u00e1p l\u00fd <\/br><span class=\"services\">H\u1ed7 tr\u1ee3 kh\u00e1ch h\u00e0ng c\u00e1c v\u1ea5n \u0111\u1ec1 ph\u00e1p l\u00fd nh\u01b0 t\u00e0i li\u1ec7u l\u1eadp k\u1ebf ho\u1ea1ch c\u00e1 nh\u00e2n v\u00e0 t\u00e0i s\u1ea3n, b\u1ecb ph\u00e2n bi\u1ec7t \u0111\u1ed1i x\u1eed, c\u00f4ng ch\u1ee9ng, n\u1ee3 n\u1ea7n ho\u1eb7c xin c\u00e1c ph\u00fac l\u1ee3i c\u00f4ng (SSI, th\u1ea5t nghi\u1ec7p).<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_41_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.3' type='checkbox'  value='Medical Case Management &lt;\/br&gt;&lt;span class=&quot;services&quot;&gt;Assists PLWH to navigate the health care system, to enter and remain in care, assist with application for services such as Medicaid, Medicare, ADAP, food, housing..etc.&lt;\/span&gt;'  id='choice_6_41_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_41_3' id='label_6_41_3' class='gform-field-label gform-field-label--type-inline'>Qu\u1ea3n l\u00fd H\u1ed3 s\u01a1 Y t\u1ebf <\/br><span class=\"services\">H\u1ed7 tr\u1ee3 ng\u01b0\u1eddi nhi\u1ec5m HIV \u0111i\u1ec1u h\u01b0\u1edbng h\u1ec7 th\u1ed1ng ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe, duy tr\u00ec \u0111i\u1ec1u tr\u1ecb, h\u1ed7 tr\u1ee3 l\u00e0m h\u1ed3 s\u01a1 xin c\u00e1c d\u1ecbch v\u1ee5 nh\u01b0 Medicaid, Medicare, ADAP, th\u1ef1c ph\u1ea9m, nh\u00e0 \u1edf, v.v.<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_41_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.4' type='checkbox'  value='Food Bank &lt;\/br&gt;&lt;span class=&quot;services&quot;&gt;Provides food, food vouchers and personal care items to help with taking medications.&lt;\/span&gt;'  id='choice_6_41_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_41_4' id='label_6_41_4' class='gform-field-label gform-field-label--type-inline'>Ng\u00e2n h\u00e0ng Th\u1ef1c ph\u1ea9m<\/br><span class=\"services\">Cung c\u1ea5p th\u1ef1c ph\u1ea9m, phi\u1ebfu th\u1ef1c ph\u1ea9m v\u00e0 c\u00e1c v\u1eadt d\u1ee5ng ch\u0103m s\u00f3c c\u00e1 nh\u00e2n \u0111\u1ec3 gi\u00fap vi\u1ec7c d\u00f9ng thu\u1ed1c.<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_41_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.5' type='checkbox'  value='Medical Transportation &lt;\/br&gt;&lt;span class=&quot;services&quot;&gt;Assists with transportation to medically related appointments using resources such as public transit tokens and\/or passes, gasoline vouchers, taxi services, or rideshares for appointments.&lt;\/span&gt;'  id='choice_6_41_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_41_5' id='label_6_41_5' class='gform-field-label gform-field-label--type-inline'>V\u1eadn chuy\u1ec3n Y t\u1ebf <\/br><span class=\"services\">H\u1ed7 tr\u1ee3 di chuy\u1ec3n \u0111\u1ebfn c\u00e1c bu\u1ed5i h\u1eb9n kh\u00e1m y t\u1ebf b\u1eb1ng ph\u01b0\u01a1ng ti\u1ec7n c\u00f4ng c\u1ed9ng nh\u01b0 v\u00e9 xe bu\u00fdt, t\u00e0u v\u00e0\/ho\u1eb7c phi\u1ebfu x\u0103ng, d\u1ecbch v\u1ee5 taxi ho\u1eb7c \u0111\u1eb7t xe cho c\u00e1c bu\u1ed5i h\u1eb9n kh\u00e1m.<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_41_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.6' type='checkbox'  value='Medications &lt;\/br&gt;&lt;span class=&quot;services&quot;&gt;Provides HIV related medications to individuals with no insurance or low coverage insurance.&lt;\/span&gt;'  id='choice_6_41_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_41_6' id='label_6_41_6' class='gform-field-label gform-field-label--type-inline'>Thu\u1ed1c <\/br><span class=\"services\">Cung c\u1ea5p thu\u1ed1c \u0111i\u1ec1u tr\u1ecb HIV cho nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng c\u00f3 b\u1ea3o hi\u1ec3m ho\u1eb7c b\u1ea3o hi\u1ec3m chi tr\u1ea3 th\u1ea5p.<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_41_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' 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