{"id":39894,"date":"2026-08-27T07:53:13","date_gmt":"2026-08-27T07:53:13","guid":{"rendered":"https:\/\/qlogicllc.com\/poncatribe\/?page_id=39894"},"modified":"2026-09-21T13:28:26","modified_gmt":"2026-09-21T13:28:26","slug":"patient-health-summary-child","status":"publish","type":"page","link":"https:\/\/qlogicllc.com\/poncatribe\/patient-health-summary-child\/","title":{"rendered":"Patient Health Summary \u2014 Child"},"content":{"rendered":"<section style=\"--hero-bg:#0D0F0E;--hero-bg-solid:#0D0F0E;--hero-min-h:580px;--hero-pad-top:0px;--hero-pad-bottom:0px;--hero-pad-x:0px;--hero-max:1504px;--hero-gap:20px;--hero-justify:flex-end;--hero-align:center;--hero-align-items:center;--hero-text-align:center;--hero-eye-gap:14px;--hero-eye-to-title:40px;--hero-title-gap:0.4em;--hero-desc-top:24px;--hero-desc-max:720px;--hero-desc-link:#DEB209;--hero-btns-gap:16px;--hero-btns-top:40px;--hero-bg-size:cover;--hero-bg-pos:center center\" class=\"ponca-hero sec_padding alignfull wp-block-ponca-page-hero\">\n\t\n\t<div class=\"container ponca-hero__container\">\n\n\t\t\t\t\t<nav class=\"ponca-hero__eyebrow\" aria-label=\"Breadcrumb\" style=\"--hero-eye-font-family:&#039;DM Sans&#039;, &#039;Helvetica Neue&#039;, sans-serif;--hero-eye-font-size:13px;--hero-eye-line-height:22px;--hero-eye-font-style:normal;--hero-eye-font-weight:600;--hero-eye-letter-spacing:3px;--hero-eye-text-transform:uppercase;\">\n\t\t\t\t\t\t\t\t\t\t<a class=\"ponca-hero__crumb\" href=\"https:\/\/qlogicllc.com\/poncatribe\/\"\n\t\t\t\t\t\t   target=\"_self\"\t\t\t\t\t\t   \t\t\t\t\t\t   style=\"--hero-crumb-color:#6e6b6d;\">Home<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"ponca-hero__eyebrow-sep\" aria-hidden=\"true\" style=\"--hero-sep-color:#A7A7A7;\">\u2022<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<a class=\"ponca-hero__crumb\" href=\"https:\/\/qlogicllc.com\/poncatribe\/tribal-court-home\/\"\n\t\t\t\t\t\t   target=\"_self\"\t\t\t\t\t\t   \t\t\t\t\t\t   style=\"--hero-crumb-color:#A7A7A7;\">Health Services<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"ponca-hero__eyebrow-sep\" aria-hidden=\"true\" style=\"--hero-sep-color:#A7A7A7;\">\u2022<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"ponca-hero__crumb ponca-hero__crumb--plain\" style=\"--hero-crumb-color:#a78607;\">Health Forms<\/span>\n\t\t\t\t\t\t\t\t<\/nav>\n\t\t\n\t\t\t\t\t<h1 class=\"ponca-hero__title ponca-hero__title--inline\" style=\"--hero-title-font-family:&#039;Cormorant Garamond&#039;, Georgia, serif;--hero-title-font-size:clamp(3rem, 1.5rem + 4vw, 96px);--hero-title-line-height:clamp(60px, 7vw, 106px);--hero-title-letter-spacing:-0.02em;\">\n\t\t\t\t\t\t\t\t\t<span class=\"ponca-hero__title-line1\" style=\"--hero-title-line1-color:#FDFDFD;--hero-title-line1-font-style:normal;--hero-title-line1-font-weight:400;\">Patient Health Summary<\/span>\t\t\t\t\t\t\t\t\t<span class=\"ponca-hero__title-line2\" style=\"--hero-title-line2-color:#DEB209;--hero-title-line2-font-style:italic;--hero-title-line2-font-weight:400;\">\u2014 Child<\/span>\n\t\t\t\t\t\t\t<\/h1>\n\t\t\n\t\t\n\t\t\n\t<\/div>\n<\/section>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-8f761849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column sec_padding has-background is-layout-flow wp-block-column-is-layout-flow\" style=\"background-color:#fffdf6\">\n<div class=\"wp-block-columns container is-layout-flex wp-container-core-columns-is-layout-8f761849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:484px\"><section style=\"--pgs-bg:transparent;--pgs-padding:0px 0px 0px 0px;--pgs-maxw:484px;--pgs-ml:0;--pgs-mr:auto;--pgs-section-gap:clamp(40px, 5.32vw, 80px);--pgs-header-gap:24px;--pgs-heading-group-gap:14px;--pgs-eyebrow-color:#DEB209;--pgs-eyebrow-font-family:DM Sans;--pgs-eyebrow-font-size:13px;--pgs-eyebrow-line-height:22px;--pgs-eyebrow-font-weight:600;--pgs-eyebrow-font-style:normal;--pgs-eyebrow-letter-spacing:3px;--pgs-eyebrow-text-transform:uppercase;--pgs-heading-color:#0D0F0E;--pgs-heading-font-family:Cormorant Garamond;--pgs-heading-font-size:56px;--pgs-heading-line-height:62px;--pgs-heading-font-weight:300;--pgs-heading-font-style:normal;--pgs-heading-letter-spacing:-0.56px;--pgs-description-color:#474747;--pgs-description-font-family:DM Sans;--pgs-description-font-size:18px;--pgs-description-line-height:30px;--pgs-description-font-weight:400;--pgs-description-font-style:normal;--pgs-description-letter-spacing:0px;--pgs-offer-gap:30px;--pgs-offer-header-color:#A78607;--pgs-offer-header-font-family:Inter;--pgs-offer-header-font-size:14px;--pgs-offer-header-line-height:17px;--pgs-offer-header-font-weight:400;--pgs-offer-header-font-style:normal;--pgs-offer-header-letter-spacing:1.4px;--pgs-offer-header-text-transform:uppercase;--pgs-offer-header-pb:14px;--pgs-items-gap:12px;--pgs-item-gap:10px;--pgs-icon-color:#A78607;--pgs-icon-size:22px;--pgs-label-color:#6E6B6D;--pgs-label-font-family:DM Sans;--pgs-label-font-size:14px;--pgs-label-line-height:25px;--pgs-label-font-weight:400;--pgs-label-font-style:normal;--pgs-label-letter-spacing:0px;--pgs-contact-gap:16px;--pgs-contact-item-gap:10px;--pgs-contact-icon-color:#A78607;--pgs-contact-icon-size:20px;--pgs-contact-text-color:#0D0F0E;--pgs-contact-text-font-family:DM Sans;--pgs-contact-text-font-size:16px;--pgs-contact-text-line-height:26px;--pgs-contact-text-font-weight:400;--pgs-contact-text-font-style:normal;--pgs-contact-text-letter-spacing:0px\" class=\"wp-block-ponca-get-started\">\n\n\t<div class=\"container ponca-gs__inner\">\n\n\t\t<!-- Header section: eyebrow + heading + description -->\n\t\t<div class=\"ponca-gs__header\">\n\n\t\t\t<div class=\"ponca-gs__heading-group\">\n\t\t\t\t\t\t\t\t\t<div class=\"ponca-gs__eyebrow\">\n\t\t\t\t\t\tGet Started\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<h2 class=\"ponca-gs__heading\">\n\t\t\t\t\t\tPatient Health Summary &#8211; Child\t\t\t\t\t<\/h2>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\t\t\t\t<p class=\"ponca-gs__description\">\n\t\t\t\t\tPlease fill out your contact information. Select the services that you are in need of or need more information about. Availability of services may be dependent on enrollment status and location.\t\t\t\t<\/p>\n\t\t\t\n\t\t\t<!-- Contact info: location + email(s) -->\n\t\t\t\t\t\t\n\t\t<\/div>\n\n\t\t<!-- Offer section: \"What We Offer\" header + checklist -->\n\t\t\n\t<\/div>\n<\/section>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:900px\">\n<script type=\"text\/javascript\" src=\"https:\/\/poncatribeofne.formstack.com\/forms\/js.php\/patient_health_summary_child\"><\/script><noscript><a href=\"https:\/\/poncatribeofne.formstack.com\/forms\/patient_health_summary_child\" title=\"Online Form\">Online Form &#8211;  Patient Health Summary \u2014 Child<\/a><\/noscript><div style=\"text-align:right; font-size:x-small;\"><a href=\"http:\/\/www.formstack.com?utm_source=jsembed&#038;utm_medium=product&#038;utm_campaign=product+branding&#038;fa=h,6583649\" title=\"Powered by Formstack\">Powered by Formstack<\/a><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Online Form &#8211; Patient Health Summary \u2014 Child Powered by Formstack<\/p>\n","protected":false},"author":80,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"inline_featured_image":false,"_mytheme_footer_image_id":0,"footnotes":""},"class_list":["post-39894","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Patient Health Summary \u2014 Child - Ponca Tribe<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/qlogicllc.com\/poncatribe\/patient-health-summary-child\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Patient Health Summary \u2014 Child - Ponca Tribe\" \/>\n<meta property=\"og:description\" content=\"Online Form &#8211; 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