{"id":62957,"date":"2019-11-07T15:14:19","date_gmt":"2019-11-07T21:14:19","guid":{"rendered":"https:\/\/www.johnhendryins.com\/insurance-louisiana\/?page_id=62957"},"modified":"2019-11-07T15:14:19","modified_gmt":"2019-11-07T21:14:19","slug":"prescription-drug-card","status":"publish","type":"page","link":"https:\/\/www.johnhendryins.com\/insurance-louisiana\/prescription-drug-card\/","title":{"rendered":"Prescription Drug Card"},"content":{"rendered":"<div align=\"center\">\n  <center><\/p>\n<table border=\"0\" cellpadding=\"0\" cellspacing=\"0\" style=\"border-collapse: collapse\" bordercolor=\"#111111\" width=\"560\" height=\"297\" id=\"AutoNumber1\">\n<tr>\n<td width=\"100%\" height=\"325\" valign=\"top\">\n<p align=\"center\">\n      <img decoding=\"async\" border=\"0\" src=\"https:\/\/cdn.agencyinfo.net\/johnhendryins-elem\/__domain_images_wp\/form=prescriptiondrugcard_text.jpg\"><\/p>\n<p align=\"center\">\n<table width=\"100%\" border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n<tr>\n<td>\n<form name=\"form1\" method=\"post\" action=\"http:\/\/net-shapers.com\/unarxcardcreator\/createdrugcardtemplate-restat.php\">\n<table border=\"0\" align=\"center\" cellpadding=\"3\" cellspacing=\"0\">\n<tr>\n<td>\n<table width=\"340\" border=\"0\" cellspacing=\"1\" cellpadding=\"2\" align=\"center\" bgcolor=\"#000000\">\n<tr bgcolor=\"#CCCCCC\" align=\"center\">\n<td colspan=\"2\"><center><\/p>\n<h2>Card Information<\/h2>\n<p><\/center><\/td>\n<\/tr>\n<tr bgcolor=\"#FFFFFF\">\n<td><font face=\"Arial, Helvetica, sans-serif\" size=\"2\">First Name<\/font><\/td>\n<td> <font face=\"Arial, Helvetica, sans-serif\" size=\"2\"><br \/>\n                    <input type=\"text\" name=\"firstName\" size=\"20\"><br \/>\n                    <\/font><\/td>\n<\/tr>\n<tr bgcolor=\"#FFFFFF\">\n<td><font face=\"Arial, Helvetica, sans-serif\" size=\"2\">Last Name<\/font><\/td>\n<td> <font face=\"Arial, Helvetica, sans-serif\" size=\"2\"><br \/>\n                    <input type=\"text\" name=\"lastName\" size=\"20\"><br \/>\n                    <\/font><\/td>\n<\/tr>\n<tr bgcolor=\"#FFFFFF\">\n<td><font face=\"Arial, Helvetica, sans-serif\" size=\"2\">Email<\/font><\/td>\n<td> <font face=\"Arial, Helvetica, sans-serif\" size=\"2\"><br \/>\n                    <input type=\"text\" name=\"email\" size=\"20\"><br \/>\n                    <\/font><\/td>\n<\/tr>\n<tr bgcolor=\"#FFFFFF\" align=\"center\">\n<td colspan=\"2\"> <input type=\"submit\" name=\"Submit\" value=\"Create Prescription Card\">\n                  <\/td>\n<\/tr>\n<\/table>\n<\/td>\n<\/tr>\n<tr>\n<td><center><br \/>\n                <font size=\"1\" face=\"Arial, Helvetica, sans-serif\"><b><font face=\"Verdana, Arial, Helvetica, sans-serif\">Note:<br \/>\n                You can put NONE in e-mail box if you don&#8217;t want updates.<br \/>\n                <\/font><\/b><br \/>\n                &copy; Copyright<br \/>\n                United Networks of America<br \/>\n                Powered by <a href=\"http:\/\/unarxcard.com\" target=\"_blank\" rel=\"noopener noreferrer\">UNA Rx Card<\/a><\/font><br \/>\n              <\/center><\/td>\n<\/tr>\n<\/table>\n<p>\n                      <input name=\"franchise\" type=\"hidden\" value=\"3\"><br \/>\n\t\t\t\t\t  <input name=\"program\" type=\"hidden\" value=\"UNARxCard\"><br \/>\n\t\t\t\t\t  <input name=\"rxgrp\" type=\"hidden\" value=\"HIAINSURERX\"><br \/>\n\t\t\t\t\t  <input name=\"fromaddress\" type=\"hidden\" value=\"cs@unarxcard.com\"><br \/>\n\t\t\t\t\t  <input name=\"disableAdditionalSavings\" type=\"hidden\" value=\"0\"><br \/>\n\t\t\t\t\t  <input name=\"disableReferralLogos\" type=\"hidden\" value=\"0\"><br \/>\n\t\t\t\t  <\/form>\n<\/td>\n<\/tr>\n<\/table>\n<\/td>\n<\/tr>\n<\/table>\n<p>  <\/center>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Card Information First Name Last Name Email Note: You can put NONE in e-mail box if you don&#8217;t want updates. &copy; Copyright United Networks of America Powered by UNA Rx 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