{"submission":{"action":"/cwbe/mail","redirect":false,"beforeSubmit":[{"statement":"model.loading = true;"}],"done":[{"statement":"model.loading = false; model.currentPage = 'confirmation';"}],"error":[{"statement":"model.loading = false; model.submissionError = true; window.scrollTo(0,0);"}]},"model":{"type":"object","properties":{"loading":{"type":"boolean","value":false,"omit":true},"currentPage":{"type":"string","value":"form","omit":true},"submissionError":{"type":"boolean","value":false,"omit":true},"dn":{"type":"string"},"au":{"type":"string","value":"/cwb1/ping"},"lu":{"type":"string"},"BG":{"type":"string","value":"sc"},"PROFILE":{"type":"string","value":"1eaX1e3X1e3X1dcX1ceX1c7X1d5X20d"},"MAIL_FORMAT":{"type":"string","value":"text"},"name_I":{"type":"string","validation":{"required":true}},"email_I":{"type":"string","validation":{"required":true,"regex":{"value":"[^@]+@[^\\.]+\\..+","message":"Email format is invalid."}}},"confirmemail_I":{"type":"string","validation":{"required":true,"condition":{"value":"model.email_I == model.confirmemail_I","message":"Email and Confirm Email must match."}}},"topic_I":{"type":"string","enum":["Technical Problems","Benefits/Claims","Buy Health Insurance/Get Rates","Change Address/Phone Number","Company Question (History, Organization, etc.)","Customer Service Feedback","Employment","EOB","ID Card Request","Provider Directory","Username/Password Issue","General Comments"],"validation":{"required":true}},"comments_I":{"type":"string","validation":{"required":true}}}},"form":[{"type":"page","name":"form","model":"currentPage","items":[{"type":"conditional","condition":"model.submissionError","items":[{"type":"alert","variant":"danger","items":["There was a problem when submitting the form. Please try again later."]}]},{"type":"input","title":"Name","model":"name_I","width":"24"},{"type":"input","title":"Email","model":"email_I","width":"24"},{"type":"input","title":"Confirm Email","model":"confirmemail_I","width":"24"},{"type":"select","title":"Topic","model":"topic_I","width":"24"},{"type":"textarea","title":"Comments","model":"comments_I"},{"type":"button","title":"Submit Feedback","variant":"primary","loading":"loading","submit":true}]},{"type":"page","name":"confirmation","model":"currentPage","items":[{"type":"alert","variant":"success","items":["Your technical issue was submitted. We will contact you via email for further updates."]}]}],"config":{"dndEditing":true}}