{"id":7134,"date":"2026-01-01T22:53:36","date_gmt":"2026-01-02T04:53:36","guid":{"rendered":"https:\/\/healthfund.org\/a\/?page_id=7134"},"modified":"2026-01-01T22:53:38","modified_gmt":"2026-01-02T04:53:38","slug":"high5-renewal-26","status":"publish","type":"page","link":"https:\/\/healthfund.org\/a\/high5-renewal-26\/","title":{"rendered":"High 5 for Mom &amp; Baby Renewal 2026"},"content":{"rendered":"<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_104_container\" data-token=\"f337922ff825d3e0bb950eeca05d102a\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_js_validate  frm_ajax_submit  frm_pro_form \" id=\"form_high-5-renewal-26\" data-token=\"f337922ff825d3e0bb950eeca05d102a\">\n<div class=\"frm_form_fields  frm_page_num_1\">\n<fieldset>\n<legend class=\"frm_screen_reader\">High 5 Renewal Application 2026<\/legend>\r\n<h3 class=\"frm_form_title\">High 5 Renewal Application 2026<\/h3>\r\n<div class=\"frm_fields_container\">\n<div class=\"frm_rootline_group\" role=\"group\" tabindex=\"0\" aria-label=\"Page 1 of 12\" ><ul class=\"frm_page_bar frm_rootline_12 frm_progress frm_progress_line  frm_show_lines frm_show_titles\"><li class=\"frm_rootline_single frm_current_page\"><span class=\"frm_rootline_title\">Basics<\/span><input type=\"button\" value=\"1\" data-page=\"\" class=\" frm_page_1\" aria-disabled=\"true\" data-field=\"0\" aria-label=\"Basics\"  \/><\/li><li class=\"frm_rootline_single\"><span class=\"frm_rootline_title\">Practice 1<\/span><input type=\"button\" value=\"2\" data-page=\"29\" class=\"frm_page_skip frm_page_2\" data-field=\"1556\" aria-label=\"Practice 1\"  \/><\/li><li class=\"frm_rootline_single\"><span class=\"frm_rootline_title\">Practice 2<\/span><input type=\"button\" value=\"3\" data-page=\"54\" class=\"frm_page_skip frm_page_3\" data-field=\"1557\" aria-label=\"Practice 2\"  \/><\/li><li class=\"frm_rootline_single\"><span class=\"frm_rootline_title\">Practice 3<\/span><input type=\"button\" value=\"4\" data-page=\"73\" class=\"frm_page_skip frm_page_4\" data-field=\"1558\" aria-label=\"Practice 3\"  \/><\/li><li class=\"frm_rootline_single\"><span class=\"frm_rootline_title\">Practice 4<\/span><input type=\"button\" value=\"5\" data-page=\"88\" class=\"frm_page_skip frm_page_5\" data-field=\"1559\" aria-label=\"Practice 4\"  \/><\/li><li class=\"frm_rootline_single\"><span class=\"frm_rootline_title\">Practice 5<\/span><input type=\"button\" value=\"6\" data-page=\"103\" class=\"frm_page_skip frm_page_6\" data-field=\"1560\" aria-label=\"Practice 5\"  \/><\/li><li class=\"frm_rootline_single\"><span class=\"frm_rootline_title\">Practice 6<\/span><input type=\"button\" value=\"7\" data-page=\"112\" class=\"frm_page_skip frm_page_7\" data-field=\"1561\" aria-label=\"Practice 6\"  \/><\/li><li class=\"frm_rootline_single\"><span class=\"frm_rootline_title\">Practice 7<\/span><input type=\"button\" value=\"8\" data-page=\"125\" class=\"frm_page_skip frm_page_8\" data-field=\"1562\" aria-label=\"Practice 7\"  \/><\/li><li class=\"frm_rootline_single\"><span class=\"frm_rootline_title\">Practice 8<\/span><input type=\"button\" value=\"9\" data-page=\"140\" class=\"frm_page_skip frm_page_9\" data-field=\"1563\" aria-label=\"Practice 8\"  \/><\/li><li class=\"frm_rootline_single\"><span class=\"frm_rootline_title\">Practice 9<\/span><input type=\"button\" value=\"10\" data-page=\"155\" class=\"frm_page_skip frm_page_10\" data-field=\"1564\" aria-label=\"Practice 9\"  \/><\/li><li class=\"frm_rootline_single\"><span class=\"frm_rootline_title\">Practice 10<\/span><input type=\"button\" value=\"11\" data-page=\"170\" class=\"frm_page_skip frm_page_11\" data-field=\"1565\" aria-label=\"Practice 10\"  \/><\/li><li class=\"frm_rootline_single\"><span class=\"frm_rootline_title\">Comments<\/span><input type=\"button\" value=\"12\" data-page=\"179\" class=\"frm_page_skip frm_page_12\" data-field=\"1566\" aria-label=\"Comments\"  \/><\/li><\/ul><div class=\"frm_percent_complete\">0% Complete<\/div><div class=\"frm_pages_complete\">1 of 12<\/div><div class=\"frm_clearfix\"><\/div><\/div><input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"104\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_104\" id=\"frm_hide_fields_104\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"high-5-renewal-26\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_104\" name=\"frm_submit_entry_104\" value=\"58f0524d88\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/a\/wp-json\/wp\/v2\/pages\/7134\" \/><div id=\"frm_field_1567_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p><strong>Kansas Hospitals and Birth Centers<\/strong>: use this online form to apply for renewal of recognition as a <em>High 5 for Mom &#038; Baby<\/em> facility. If helpful, you can <a href=\"https:\/\/healthfund.org\/a\/wp-content\/uploads\/High-5-Renewal-Form-Sample-2026.pdf\">download an offline sample<\/a> to gather the information to enter into the official online form below. <strong>If your facility is recognized as High 5 Premier<\/strong> (all ten practices), please use the <a href=\"https:\/\/healthfund.org\/a\/high5-premier-renewal-26\/\">streamlined renewal form available here<\/a> instead of the below form.<\/p>\n<p>If you have questions about <a href=\"https:\/\/high5kansas.org\">High 5 for Mom &#038; Baby<\/a> or the renewal process, please contact program coordinator Cara Gerhardt coordinator@high5kansas.org. Thank you for your continued commitment to helping ensure successful breastfeeding for Mom &#038; Baby!<\/p>\n<p><em>Note: upon submission of the below form, an email confirmation will be sent to the address entered in the email field below. If you want to save a partial form for later completion, please use the Save Draft function at the bottom of the form. <\/em><\/p>\n<\/div>\n<div id=\"frm_field_1457_container\" class=\"frm_form_field frm_section_heading form-field  frm12 frm_first\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">High 5 Renewal Basic Information<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1458_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n\t<label for=\"field_eafyq2\" id=\"field_eafyq2_label\" class=\"frm_primary_label\">Date\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_eafyq2\" name=\"item_meta[1458]\" value=\"04\/16\/2026\"  data-sectionid=\"1457\"  maxlength=\"10\" data-frmval=\"04\/16\/2026\" data-reqmsg=\"Date cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1459_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n\t<label for=\"field_ckd9s2\" id=\"field_ckd9s2_label\" class=\"frm_primary_label\">Facility Name\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_ckd9s2\" name=\"item_meta[1459]\" value=\"\"  data-sectionid=\"1457\"  data-reqmsg=\"Facility Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Facility Name is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1460_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n\t<label for=\"field_iji82\" id=\"field_iji82_label\" class=\"frm_primary_label\">Facility City\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_iji82\" name=\"item_meta[1460]\" value=\"\"  data-reqmsg=\"Facility City cannot be blank.\" aria-required=\"true\" data-invmsg=\"Facility City is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1461_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<div  id=\"field_mg19w2_label\" class=\"frm_primary_label\">Your Name\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<fieldset aria-labelledby=\"field_mg19w2_label\">\n\t<legend class=\"frm_screen_reader frm_hidden\">\n\t\tYour Name\t<\/legend>\n\n\t<div  class=\"frm_combo_inputs_container\" id=\"frm_combo_inputs_container_1461\" data-name-layout=\"first_last\">\n\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_1461-first_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-first  frm6\"\n\t\t\t\tdata-sub-field-name=\"first\"\n\t\t\t>\n\t\t\t\t<label for=\"field_mg19w2_first\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tFirst Name\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_mg19w2_first\" value=\"\" name=\"item_meta[1461][first]\" autocomplete=\"given-name\" data-sectionid=\"1457\"  data-reqmsg=\"Your Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Your Name is invalid\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_1461_first_desc\">First Name<\/div>\t\t\t<\/div>\n\t\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_1461-last_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-last  frm6\"\n\t\t\t\tdata-sub-field-name=\"last\"\n\t\t\t>\n\t\t\t\t<label for=\"field_mg19w2_last\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tLast Name\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_mg19w2_last\" value=\"\" name=\"item_meta[1461][last]\" autocomplete=\"family-name\" data-sectionid=\"1457\"  data-reqmsg=\"Your Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Your Name is invalid\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_1461_last_desc\">Last Name<\/div>\t\t\t<\/div>\n\t\t\t\t<\/div>\n<\/fieldset>\n\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1462_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n\t<label for=\"field_e5thy2\" id=\"field_e5thy2_label\" class=\"frm_primary_label\">Email\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"email\" id=\"field_e5thy2\" name=\"item_meta[1462]\" value=\"\"  data-sectionid=\"1457\"  autocomplete=\"email\"  data-reqmsg=\"Email cannot be blank.\" aria-required=\"true\" data-invmsg=\"Email is invalid\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_conf_1462_container\" class=\"frm_form_field frm_hidden_container frm_conf_field form-field  frm_required_field frm_top_container  frm6\">\r\n\t<label for=\"field_conf_e5thy2\" id=\"field_conf_e5thy2_label\" class=\"frm_conf_label frm_primary_label\">Confirm Email\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"email\" id=\"field_conf_e5thy2\" name=\"item_meta[conf_1462]\" value=\"\"  data-sectionid=\"1457\"  autocomplete=\"email\"  placeholder=\"Confirm email\" data-reqmsg=\"Confirm Email cannot be blank.\" aria-required=\"true\" data-confmsg=\"The entered values do not match\" data-invmsg=\"Confirm Email is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_conf_e5thy2\"\/>\r\n\t<div class=\"frm_description\" id=\"frm_desc_field_conf_e5thy2\">Confirm email<\/div>\r\n\t\r\n<\/div>\n<div id=\"frm_field_1463_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_ovydp2\" id=\"field_ovydp2_label\" class=\"frm_primary_label\">Number of deliveries last year\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"number\" id=\"field_ovydp2\" name=\"item_meta[1463]\" value=\"\" data-sectionid=\"1457\"  data-reqmsg=\"Number of deliveries last year cannot be blank.\" aria-required=\"true\" data-invmsg=\"Number of deliveries last year is invalid\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_2179_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top\">Informational Questions<\/h3>\r\n<div id=\"frm_desc_field_7d8vz\" class=\"frm_description frm_section_spacing\">The questions in this first section are intended to inform potential future improvements to High 5, and your responses will not affect renewal eligibility in any way. We appreciate your input.<\/div>\r\n\r\n<div id=\"frm_field_2181_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n\t<div  id=\"field_vkuqp_label\" class=\"frm_primary_label\">1. Does your facility currently offer pasteurized\u00a0donor human milk to patients who require feeding supplementation?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_vkuqp_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_2181-2179-0\">\t\t\t<label  for=\"field_vkuqp-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[2181]\" id=\"field_vkuqp-0\" value=\"Yes\"\n\t\t data-sectionid=\"2179\"  data-invmsg=\"1. Does your facility currently offer pasteurized\u00a0donor human milk to patients who require feeding supplementation? is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_2181-2179-1\">\t\t\t<label  for=\"field_vkuqp-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[2181]\" id=\"field_vkuqp-1\" value=\"No\"\n\t\t data-sectionid=\"2179\"  data-invmsg=\"1. Does your facility currently offer pasteurized\u00a0donor human milk to patients who require feeding supplementation? is invalid\"   \/> No<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_2181-2179-2\">\t\t\t<label  for=\"field_vkuqp-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[2181]\" id=\"field_vkuqp-2\" value=\"Uncertain\"\n\t\t data-sectionid=\"2179\"  data-invmsg=\"1. Does your facility currently offer pasteurized\u00a0donor human milk to patients who require feeding supplementation? is invalid\"   \/> Uncertain<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_2182_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_2staf\" id=\"field_2staf_label\" class=\"frm_primary_label\">1a. If yes, please attach any policies,\u00a0handouts, or documentation you use\u00a0related to providing pasteurized donor human milk.\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"hidden\"  data-sectionid=\"2179\"  data-invmsg=\"1a. If yes, please attach any policies,\u00a0handouts, or documentation you use\u00a0related to providing pasteurized donor human milk. is invalid\" aria-invalid=\"false\"   name=\"item_meta[2182][]\"  value=\"\" data-frmfile=\"2182\" \/>\n\n<div class=\"frm_dropzone frm_multi_upload frm_clearfix\" id=\"file2182_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file2182[]\" id=\"field_2staf\"\n\t\t\t data-frmfile=\"2182\" multiple=\"multiple\"  data-sectionid=\"2179\"  data-invmsg=\"1a. If yes, please attach any policies,\u00a0handouts, or documentation you use\u00a0related to providing pasteurized donor human milk. is invalid\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"1a. If yes, please attach any policies,\u00a0handouts, or documentation you use\u00a0related to providing pasteurized donor human milk.. Drop a file here or click to upload. Maximum file size: 67.11MB\">Drop a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"1a. If yes, please attach any policies,\u00a0handouts, or documentation you use\u00a0related to providing pasteurized donor human milk.. Choose File. Maximum file size: 67.11MB\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 67.11MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_2183_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio frm_other_container\">\r\n\t<div  id=\"field_8f7iw_label\" class=\"frm_primary_label\">1b. If no, what are the barriers to offering pasteurized human donor milk? (Please choose all which apply)\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_8f7iw_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_2183-2179-0\">\t\t\t<label  for=\"field_8f7iw-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[2183][]\" id=\"field_8f7iw-0\" value=\"Cost\"  data-sectionid=\"2179\"  data-invmsg=\"1b. If no, what are the barriers to offering pasteurized human donor milk? (Please choose all which apply) is invalid\"   \/> Cost<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_2183-2179-1\">\t\t\t<label  for=\"field_8f7iw-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[2183][]\" id=\"field_8f7iw-1\" value=\"Uncertainty about how to obtain donor milk\"  data-sectionid=\"2179\"  data-invmsg=\"1b. If no, what are the barriers to offering pasteurized human donor milk? (Please choose all which apply) is invalid\"   \/> Uncertainty about how to obtain donor milk<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_2183-2179-2\">\t\t\t<label  for=\"field_8f7iw-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[2183][]\" id=\"field_8f7iw-2\" value=\"Provider concerns\"  data-sectionid=\"2179\"  data-invmsg=\"1b. If no, what are the barriers to offering pasteurized human donor milk? (Please choose all which apply) is invalid\"   \/> Provider concerns<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_2183-2179-3\">\t\t\t<label  for=\"field_8f7iw-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[2183][]\" id=\"field_8f7iw-3\" value=\"Provider lack of interest\"  data-sectionid=\"2179\"  data-invmsg=\"1b. If no, what are the barriers to offering pasteurized human donor milk? (Please choose all which apply) is invalid\"   \/> Provider lack of interest<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_2183-2179-4\">\t\t\t<label  for=\"field_8f7iw-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[2183][]\" id=\"field_8f7iw-4\" value=\"Family concerns\"  data-sectionid=\"2179\"  data-invmsg=\"1b. If no, what are the barriers to offering pasteurized human donor milk? (Please choose all which apply) is invalid\"   \/> Family concerns<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_2183-2179-5\">\t\t\t<label  for=\"field_8f7iw-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[2183][]\" id=\"field_8f7iw-5\" value=\"Family lack of knowledge or interest\"  data-sectionid=\"2179\"  data-invmsg=\"1b. If no, what are the barriers to offering pasteurized human donor milk? (Please choose all which apply) is invalid\"   \/> Family lack of knowledge or interest<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_2183-2179-6\">\t\t\t<label  for=\"field_8f7iw-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[2183][]\" id=\"field_8f7iw-6\" value=\"Storage concerns\"  data-sectionid=\"2179\"  data-invmsg=\"1b. If no, what are the barriers to offering pasteurized human donor milk? (Please choose all which apply) is invalid\"   \/> Storage concerns<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_2183-2179-7\">\t\t\t<label  for=\"field_8f7iw-7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[2183][]\" id=\"field_8f7iw-7\" value=\"Workflow issues or concerns\"  data-sectionid=\"2179\"  data-invmsg=\"1b. If no, what are the barriers to offering pasteurized human donor milk? (Please choose all which apply) is invalid\"   \/> Workflow issues or concerns<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_2183-2179-8\">\t\t\t<label  for=\"field_8f7iw-8\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[2183][]\" id=\"field_8f7iw-8\" value=\"Safety of donor milk\"  data-sectionid=\"2179\"  data-invmsg=\"1b. If no, what are the barriers to offering pasteurized human donor milk? (Please choose all which apply) is invalid\"   \/> Safety of donor milk<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_2183-2179-other_9\">\t\t\t<label  for=\"field_8f7iw-other_9\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[2183][other_9]\" id=\"field_8f7iw-other_9\" value=\"Other\"  data-sectionid=\"2179\"  data-invmsg=\"1b. If no, what are the barriers to offering pasteurized human donor milk? (Please choose all which apply) is invalid\"   \/> Other<\/label><label for=\"field_8f7iw-other_9-otext\" class=\"frm_screen_reader frm_hidden\">Other<\/label><input type=\"text\" id=\"field_8f7iw-other_9-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][2183][other_9]\" value=\"\" \/><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_1465_container\" class=\"frm_form_field  frm_html_container form-field\">\n<h4><strong>The following Facility Self-Assessment questions relate to the evidence-based High 5 for Mom &#038; Baby practices supporting successful breastfeeding.<\/strong><\/h4>\n<p><strong><em>Application responses should accurately reflect hospital policies and the patient education provided by trained staff.\u00a0<\/em><\/strong><\/p>\n<p><strong>High 5 recognized facilities should answer questions relating to the five or more practices being followed.<\/strong><\/p>\n<p><strong>Note: High 5 for Mom &#038; Baby Premier<\/strong> facilities (implementing all 10 practices) should use the streamlined form at <a href=\"https:\/\/healthfund.org\/a\/high5-premier-renewal-26\">https:\/\/healthfund.org\/a\/high5-premier-renewal-26<\/a> instead of this form.<\/p>\n<p><strong>The High 5 for Mom &#038; Baby Practices:<\/strong><\/p>\n<ol>\n<li>Facility will have a written maternity care and infant feeding policy addressing the High 5 for Mom &#038; Baby practices supporting breastfeeding<\/li>\n<li>Facility will maintain staff competency in lactation support<\/li>\n<li>All pregnant women will receive information and instruction on breastfeeding<\/li>\n<li>Assure immediate and sustained skin-to-skin contact between mother and baby after birth<\/li>\n<li>All families will receive individualized infant feeding counseling<\/li>\n<li>Give newborn infants no food or drink other than breastmilk unless medically indicated<\/li>\n<li>Practice &#8220;rooming in&#8221; &#8211; allow mothers and infants to remain together 24 hours a day<\/li>\n<li>Families will be encouraged to feed their babies when the baby exhibits feeding cues, regardless of feeding methods<\/li>\n<li>Give no pacifiers or artificial nipples to breastfeeding infants<\/li>\n<li>Provide mothers options for breastfeeding support in the community (such as a telephone number, walk-in clinic information, support groups, etc.) upon discharge<\/li>\n<\/ol>\n<\/div>\n<input type=\"hidden\" name=\"frm_page_order_104\" id=\"frm_page_order_104\" value=\"29\" \/>\t\t<input  type=\"hidden\" name=\"item_meta[1466]\" id=\"field_ndwdz2\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1467]\" id=\"field_3kyu92-0\" value=\"\"  data-sectionid=\"1466\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1555]\" id=\"field_pgct8-0\" value=\"\"  data-sectionid=\"1466\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1468]\" id=\"field_izfqe2\" value=\"\"  data-sectionid=\"1466\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1469]\" id=\"field_dvd7r2-0\" value=\"\"  data-sectionid=\"1466\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1490]\" id=\"field_jfvq4\" value=\"\"  data-sectionid=\"1466\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1492]\" id=\"field_gdivr-0\" value=\"\"  data-sectionid=\"1466\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1495]\" id=\"field_mvgxa-0\" value=\"\"  data-sectionid=\"1466\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1496]\" id=\"field_fhpmz-0\" value=\"\"  data-sectionid=\"1466\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1470]\" id=\"field_qj0c2\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1471]\" id=\"field_od8ca2\" value=\"\"  data-sectionid=\"1466\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1472]\" id=\"field_5jvsu2\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1557]\" id=\"field_zd85u\" value=\"\"     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name=\"item_meta[1498]\" id=\"field_j589d\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1558]\" id=\"field_hif23\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1506]\" id=\"field_tnwys\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1508]\" id=\"field_vin2n-0\" value=\"\"  data-sectionid=\"1506\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1509]\" id=\"field_th6ih-0\" value=\"\"  data-sectionid=\"1506\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1510]\" id=\"field_66o1i\" value=\"\"  data-sectionid=\"1506\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1511]\" id=\"field_gbaah-0\" value=\"\"  data-sectionid=\"1506\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1512]\" id=\"field_jic2g\" value=\"\"  data-sectionid=\"1506\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1507]\" id=\"field_4kk11\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1559]\" id=\"field_qecrk\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1513]\" id=\"field_7mbuo\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1515]\" id=\"field_idb8c-0\" value=\"\"  data-sectionid=\"1513\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1516]\" id=\"field_slte0-0\" value=\"\"  data-sectionid=\"1513\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1517]\" id=\"field_2zuxy-0\" value=\"\"  data-sectionid=\"1513\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1518]\" id=\"field_j4mc4-0\" value=\"\"  data-sectionid=\"1513\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1519]\" id=\"field_visuy-0\" value=\"\"  data-sectionid=\"1513\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1514]\" id=\"field_jf7l\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1560]\" id=\"field_fi59h\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1520]\" id=\"field_fzjie\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1522]\" id=\"field_32j42-0\" value=\"\"  data-sectionid=\"1520\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1523]\" id=\"field_ksfrx-0\" value=\"\"  data-sectionid=\"1520\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1521]\" id=\"field_4u3tl\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1561]\" id=\"field_x7h4z\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1524]\" id=\"field_5r7i6\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1526]\" id=\"field_mwp1r-0\" value=\"\"  data-sectionid=\"1524\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1527]\" id=\"field_jc7f2-0\" value=\"\"  data-sectionid=\"1524\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1528]\" id=\"field_p0y68-0\" value=\"\"  data-sectionid=\"1524\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1529]\" id=\"field_l03mu-0\" value=\"\"  data-sectionid=\"1524\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1525]\" id=\"field_kp4cc\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1562]\" id=\"field_qdhjq\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1530]\" id=\"field_scd3e\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1532]\" id=\"field_s4k8a-0\" value=\"\"  data-sectionid=\"1530\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1533]\" id=\"field_j0sbl-0\" value=\"\"  data-sectionid=\"1530\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1534]\" id=\"field_3qvbf-0\" value=\"\"  data-sectionid=\"1530\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1535]\" id=\"field_1wztr-0\" value=\"\"  data-sectionid=\"1530\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1536]\" id=\"field_4h31i-0\" value=\"\"  data-sectionid=\"1530\"     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\/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1564]\" id=\"field_3q3ca\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1544]\" id=\"field_t5i4a\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1546]\" id=\"field_onqlr-0\" value=\"\"  data-sectionid=\"1544\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1547]\" id=\"field_khrq7-0\" value=\"\"  data-sectionid=\"1544\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1548]\" id=\"field_dhud3-0\" value=\"\"  data-sectionid=\"1544\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1549]\" id=\"field_db2tx-0\" value=\"\"  data-sectionid=\"1544\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1550]\" id=\"field_r4e62-0\" value=\"\"  data-sectionid=\"1544\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1545]\" id=\"field_k1ise\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1565]\" id=\"field_889el\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1551]\" id=\"field_o7dj0\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1553]\" id=\"field_8f8a-0\" value=\"\"  data-sectionid=\"1551\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1554]\" id=\"field_gt70o-0\" value=\"\"  data-sectionid=\"1551\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1552]\" id=\"field_6pmch\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1566]\" id=\"field_9i3wz\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1473]\" id=\"field_ka1232\" value=\"\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1486]\" id=\"field_xnf8g2\" value=\"\"  data-sectionid=\"1473\"     \/>\n\t\t\t\t<input  type=\"hidden\" name=\"item_meta[1487]\" id=\"field_myvmv2\" value=\"\"     \/>\n\t\t<input type=\"hidden\" name=\"item_meta[1489]\" id=\"field_dx23w2\" value=\"\" data-frmval=\"\"\/>\n\t\t<input  type=\"hidden\" name=\"item_meta[1488]\" id=\"field_submit42\" value=\"\"     \/>\n\t\t\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_2386_container\">\n\t\t\t<label for=\"field_1n720\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_1n720\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[2386]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<style>.frm-abandonment-modal * {\n\tbox-sizing: border-box;\n}\n\n.frm-abandonment-modal {\n\tposition: fixed;\n\ttop: 0;\n\tright: 0;\n\tbottom: 0;\n\tleft: 0;\n\tz-index: 1000;\n\tdisplay: flex;\n\tflex-direction: column;\n\talign-items: center;\n\tvisibility: hidden;\n\toverflow: hidden;\n\topacity: 0;\n\t-webkit-overflow-scrolling: touch;\n}\n\n.frm-abandonment-modal .tingle-modal__close {\n\tdisplay: none;\n}\n\n.frm-abandonment-modal .tingle-modal-box {\n\tposition: relative;\n\tflex-shrink: 0;\n\tmargin-top: auto;\n\tmargin-bottom: auto;\n\tmax-width: 345px;\n\tbackground: #fff;\n\topacity: 1;\n\tcursor: auto;\n\tborder-radius: var(--border-radius);\n\twill-change: transform, opacity;\n\tpadding: 1.5rem;\n\tbox-shadow: 1px 1px 11px 2px rgba(0, 0, 0, 0.2);\n}\n\n.frm-abandonment-modal .tingle-modal-box__content h3{\n\tmargin-top: 0;\n}\n\na.frm-abandonment-close {\n\tposition: absolute;\n\ttop: 10px;\n\tright: 5%;\n\ttext-decoration: none;\n\tcolor: currentColor;\n\topacity: .8;\n\tfont-size: 30px;\n\tfont-weight: 300;\n\tline-height: 21px;\n}\n\n.frm-abandonment-btn-invisible {\n\topacity: 0;\n}\n\n.tingle-enabled {\n\tposition: fixed;\n\tright: 0;\n\tleft: 0;\n\toverflow: hidden;\n}\n\n.frm-abandonment-modal.tingle-modal--visible .tingle-modal-box__footer {\n\tbottom: 0;\n}\n\n.frm-abandonment-modal.tingle-modal--visible {\n\tvisibility: visible;\n\topacity: 1;\n\tbackground: rgba(0, 0, 0, 0.5);\n}\n\n.frm-abandonment-modal.tingle-modal--visible .tingle-modal-box {\n\tanimation: abdn-scale .2s cubic-bezier(.68, -.55, .265, 1.55) forwards;\n}\n\n.tingle-modal--overflow {\n\toverflow-y: scroll;\n\tpadding-top: 8px;\n}\n\n@keyframes abdn-scale {\n\t0% {\n\t\topacity: 0;\n\t\ttransform: scale(.9);\n\t}\n\t100% {\n\t\topacity: 1;\n\t\ttransform: scale(1);\n\t}\n}<\/style><input type=\"hidden\" name=\"auto_save\" value=\"20000\"\/><input type=\"hidden\" name=\"current_page\" value=\"7134\"\/><input type=\"hidden\" name=\"frm_saving_draft\" class=\"frm_saving_draft\" value=\"\" \/><input name=\"frm_state\" type=\"hidden\" value=\"ZY9cPbBeRx8YNL663tp7vsWF5hjjZuUO8w2aROjDKddQC642duPCbwwxV7liU4jo\" \/><div class=\"frm_submit frm_flex\">\r\n<button class=\"frm_button_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Next Page<\/button>\r\n\r\n<button class=\"frm_save_draft\" >Save Draft<\/button>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":3938,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-contact-hi5.php","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-7134","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/healthfund.org\/a\/wp-json\/wp\/v2\/pages\/7134","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/healthfund.org\/a\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/healthfund.org\/a\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/healthfund.org\/a\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/healthfund.org\/a\/wp-json\/wp\/v2\/comments?post=7134"}],"version-history":[{"count":7,"href":"https:\/\/healthfund.org\/a\/wp-json\/wp\/v2\/pages\/7134\/revisions"}],"predecessor-version":[{"id":8873,"href":"https:\/\/healthfund.org\/a\/wp-json\/wp\/v2\/pages\/7134\/revisions\/8873"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/healthfund.org\/a\/wp-json\/wp\/v2\/media\/3938"}],"wp:attachment":[{"href":"https:\/\/healthfund.org\/a\/wp-json\/wp\/v2\/media?parent=7134"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}