{"id":3346,"date":"2023-01-22T10:39:35","date_gmt":"2023-01-22T15:39:35","guid":{"rendered":"https:\/\/electric-liquid.flywheelsites.com\/?page_id=3346"},"modified":"2026-03-16T11:22:08","modified_gmt":"2026-03-16T15:22:08","slug":"home-health-services","status":"publish","type":"page","link":"https:\/\/peconiclanding.org\/health-services\/home-health-services\/","title":{"rendered":"Home Health Services"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"3346\" class=\"elementor elementor-3346\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-9cde99c elementor-reverse-mobile elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"9cde99c\" data-element_type=\"section\" data-e-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-top-column elementor-element elementor-element-12fdf51\" data-id=\"12fdf51\" data-element_type=\"column\" data-e-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-3ecb365 elementor-widget elementor-widget-heading\" data-id=\"3ecb365\" data-element_type=\"widget\" data-e-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\">Home Health Services on Long Island, NY<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-eb619cc elementor-widget elementor-widget-heading\" data-id=\"eb619cc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Providing in-home care on the North Fork and Shelter Island<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-2669144 e-con-full e-flex e-con e-parent\" data-id=\"2669144\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-dc9ffa5 e-con-full e-flex e-con e-child\" data-id=\"dc9ffa5\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-dc7ce24 elementor-widget elementor-widget-heading\" data-id=\"dc7ce24\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Home Care Professionals:<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0d914a1 elementor-widget elementor-widget-text-editor\" data-id=\"0d914a1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Guided by our person-centered home care philosophy, our licensed care professionals work to create a comprehensive care plan based on the client&#8217;s desires and recommendations from the client&#8217;s personal physician.<\/p><ul><li>Registered Nurse (RN)<\/li><li>Licensed Practical Nurse (LPN)<\/li><li>Home Health Aide (HHA)<\/li><li>Companions<\/li><li>Personal Assistants<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-bfdac1e e-con-full e-flex e-con e-child\" data-id=\"bfdac1e\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ce55a1f elementor-widget elementor-widget-heading\" data-id=\"ce55a1f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">In-Home Personal Care Services:<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-108b6ac elementor-widget elementor-widget-text-editor\" data-id=\"108b6ac\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Sometimes the comfort of a helping hand is all we need. Benefit from the assistance of our experienced and highly trained caregivers that provide the care needed to support a successful and independent life.<\/p><ul><li><a href=\"https:\/\/peconiclanding.org\/health-services\/respite-care\/\">Memory Care Respite<\/a><\/li><li>Daily Personal Care (Bathing, Dressing, Toileting, Nutrition, Socialization)<\/li><li>Medication Oversight<\/li><li>Post-Surgical Support<\/li><li>Household Management<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-ff41984 e-flex e-con-boxed e-con e-parent\" data-id=\"ff41984\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7e9b980 elementor-widget elementor-widget-heading\" data-id=\"7e9b980\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Live-In Home Health Services<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2198ed5 elementor-widget elementor-widget-text-editor\" data-id=\"2198ed5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>When around-the-clock support brings peace of mind, our live-in care makes it possible to remain safely at home \u2014 with a trusted caregiver providing continuous assistance day and night. Our team matches each client with the right caregiver and builds a personalized plan overseen by nursing.<\/p><ul><li>Continuous companionship and supervision \u2014 ideal for memory support or safety concerns<\/li><li>Personal care such as bathing, dressing and grooming<\/li><li>Mobility assistance and fall prevention<\/li><li>Meal planning and preparation<\/li><li>Medication reminders and care coordination with your medical team<\/li><li>Light housekeeping and laundry<\/li><li>Transportation and escort to appointments<\/li><li>Respite for family caregivers<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2a2f29d elementor-widget elementor-widget-heading\" data-id=\"2a2f29d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Additional Services:<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0579beb elementor-widget elementor-widget-text-editor\" data-id=\"0579beb\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<ul><li>Home Organization<\/li><li>Social Companionship<\/li><li>Light Housekeeping and Laundry<\/li><li>Shopping and Errands<\/li><li>Safety and Supervision<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ae51e7e elementor-widget elementor-widget-button\" data-id=\"ae51e7e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/peconiclanding.org\/home-health-care\/\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Learn more<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9ef0550 elementor-testimonial--skin-default elementor-testimonial--layout-image_inline elementor-testimonial--align-center elementor-arrows-yes elementor-pagination-type-bullets elementor-widget elementor-widget-testimonial-carousel\" data-id=\"9ef0550\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;lazyload&quot;:&quot;yes&quot;,&quot;show_arrows&quot;:&quot;yes&quot;,&quot;pagination&quot;:&quot;bullets&quot;,&quot;speed&quot;:500,&quot;autoplay&quot;:&quot;yes&quot;,&quot;autoplay_speed&quot;:5000,&quot;loop&quot;:&quot;yes&quot;,&quot;pause_on_hover&quot;:&quot;yes&quot;,&quot;pause_on_interaction&quot;:&quot;yes&quot;,&quot;space_between&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:10,&quot;sizes&quot;:[]},&quot;space_between_laptop&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:10,&quot;sizes&quot;:[]},&quot;space_between_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:10,&quot;sizes&quot;:[]},&quot;space_between_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:10,&quot;sizes&quot;:[]}}\" data-widget_type=\"testimonial-carousel.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-swiper\">\n\t\t\t\t\t<div class=\"elementor-main-swiper swiper\" role=\"region\" aria-roledescription=\"carousel\" aria-label=\"Slides\">\n\t\t\t\t<div class=\"swiper-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"swiper-slide\" role=\"group\" aria-roledescription=\"slide\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-testimonial\">\n\t\t\t\t\t\t\t<div class=\"elementor-testimonial__content\">\n\t\t\t\t\t<div class=\"elementor-testimonial__text\">\n\t\t\t\t\t\tBecause my family is scattered all over the country, I had no one to help me to adjust to my new surroundings. Peconic Landing's Home Health Services paired me with a personal assistant who helped me unpack boxes and sort items for donation. Now she comes over twice a week to help me with chores which frees up my time so I can focus on my health and hobbies. Her companionship and support is so comforting -- she has truly been a miracle in my life.\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"elementor-testimonial__footer\">\n\t\t\t\t\t\t\t\t<cite class=\"elementor-testimonial__cite\"><span class=\"elementor-testimonial__name\">Marion Salgado<\/span><span class=\"elementor-testimonial__title\">Peconic Landing Independent Living Member<\/span><\/cite>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"swiper-slide\" role=\"group\" aria-roledescription=\"slide\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-testimonial\">\n\t\t\t\t\t\t\t<div class=\"elementor-testimonial__content\">\n\t\t\t\t\t<div class=\"elementor-testimonial__text\">\n\t\t\t\t\t\tI have been living in Independent Living for the past five years. Everything was great but now I find I need some additional support. The home care team has been right there to help me, and they go above and beyond the call of duty. They anticipate my every need, do an outstanding job, are constantly dependable, and have wonderful attitudes. I feel so blessed to have them in my life.\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"elementor-testimonial__footer\">\n\t\t\t\t\t\t\t\t<cite class=\"elementor-testimonial__cite\"><span class=\"elementor-testimonial__name\">Harriet Donopria<\/span><span class=\"elementor-testimonial__title\">Peconic Landing Independent Living Member<\/span><\/cite>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"swiper-slide\" role=\"group\" aria-roledescription=\"slide\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-testimonial\">\n\t\t\t\t\t\t\t<div class=\"elementor-testimonial__content\">\n\t\t\t\t\t<div class=\"elementor-testimonial__text\">\n\t\t\t\t\t\tWe believe in vibrant and engaged living. Our caregivers in addition to providing essential support encourage clients to maintain their passions and interests, creating a sense of purpose and joy.\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"elementor-testimonial__footer\">\n\t\t\t\t\t\t\t\t<cite class=\"elementor-testimonial__cite\"><span class=\"elementor-testimonial__name\">Susan Croce<\/span><span class=\"elementor-testimonial__title\">PLHHS Administrator<\/span><\/cite>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"elementor-swiper-button elementor-swiper-button-prev\" role=\"button\" tabindex=\"0\" aria-label=\"Previous\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-chevron-left\"><\/i>\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"elementor-swiper-button elementor-swiper-button-next\" role=\"button\" tabindex=\"0\" aria-label=\"Next\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-chevron-right\"><\/i>\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"swiper-pagination\"><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6fa6328 elementor-widget elementor-widget-text-editor\" data-id=\"6fa6328\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h4>To receive more information, to schedule an in-home visit, or to inquire about a career in Home Health, contact Susan Croce, Home Health Services Administrator by calling <a href=\"tel:631-477-2146\">631-477-2146<\/a>\u00a0or by using the form below.<\/h4>\t\t\t\t\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<div class=\"elementor-element elementor-element-ee823cb e-flex e-con-boxed e-con e-parent\" 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data-settings=\"{&quot;motion_fx_motion_fx_scrolling&quot;:&quot;yes&quot;,&quot;motion_fx_devices&quot;:[&quot;desktop&quot;,&quot;laptop&quot;,&quot;tablet&quot;,&quot;mobile&quot;]}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\">Providing in-home care on the North Fork and Shelter Island<\/span>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-015e960 e-flex e-con-boxed e-con e-parent\" data-id=\"015e960\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3207cdb elementor-widget elementor-widget-shortcode\" data-id=\"3207cdb\" data-element_type=\"widget\" data-e-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\"><h2>Contact Our Team<\/h2><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_unknown gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_20' >\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Home Health Services<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_20'  action='\/wp-json\/wp\/v2\/pages\/3346' data-formid='20' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_20' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_20_3\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_20_3'>\n                            \n                            <span id='input_20_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.3' id='input_20_3_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_20_3_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_20_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.6' id='input_20_3_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_20_3_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_20_4\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_20_4'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_4' id='input_20_4' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_20_5\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below 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ginput_container_address gform-grid-row' id='input_20_11' >\n                        <input type='hidden' class='gform_hidden' name='input_11.4' id='input_20_11_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_20_11_5_container' >\n                                    <input type='text' name='input_11.5' id='input_20_11_5' value=''    aria-required='true'    \/>\n                                    <label for='input_20_11_5' id='input_20_11_5_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_11.6' id='input_20_11_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_20_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I am requesting information on behalf of:<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_20_10'>\n\t\t\t<div class='gchoice gchoice_20_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Myself'  id='choice_20_10_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_10_0' id='label_20_10_0' class='gform-field-label gform-field-label--type-inline'>Myself<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_20_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Parents'  id='choice_20_10_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_10_1' id='label_20_10_1' class='gform-field-label 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