{"id":51271,"date":"2025-08-12T11:11:41","date_gmt":"2025-08-12T09:11:41","guid":{"rendered":"https:\/\/dev.institutchiaribcn.com\/test-enfermedad-filum\/"},"modified":"2026-04-02T10:11:00","modified_gmt":"2026-04-02T08:11:00","slug":"%e7%bb%88%e4%b8%9d%e7%96%be%e7%97%85%e6%a6%82%e7%8e%87%e6%a3%80%e6%b5%8b","status":"publish","type":"page","link":"https:\/\/institutchiaribcn.com\/cn\/%e7%bb%88%e4%b8%9d%e7%96%be%e7%97%85%e6%a6%82%e7%8e%87%e6%a3%80%e6%b5%8b\/","title":{"rendered":"Test Institut Chiari"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"51271\" class=\"elementor elementor-51271 elementor-48668\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-261dbdf e-flex e-con-boxed e-con e-parent\" data-id=\"261dbdf\" 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<div class=\"elementor-element elementor-element-f6cd230 e-con-full e-flex e-con e-child\" data-id=\"f6cd230\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-9446ae8 elementor-widget elementor-widget-heading\" data-id=\"9446ae8\" 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\">\u60f3\u77e5\u9053\u4f60\u6709\u6ca1\u6709\u7ec8\u4e1d\u75be\u75c5\u5417\uff1f\u514d\u8d39\u5728\u7ebf\u6d4b\u8bd5\u3002<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-207b628 elementor-widget elementor-widget-heading\" data-id=\"207b628\" 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\">\u7ec8\u4e1d\u75be\u75c5\u6982\u7387\u68c0\u6d4b<\/h2>\t\t\t\t<\/div>\n\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-3e9ce7d e-flex e-con-boxed e-con e-parent\" data-id=\"3e9ce7d\" 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-22413d5 elementor-widget elementor-widget-shortcode\" data-id=\"22413d5\" 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\"><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_gecko gform_wrapper gform-theme gform-theme--foundation gform-theme--framework gform-theme--orbital' data-form-theme='orbital' data-form-index='0' id='gform_wrapper_1' style='display:none'><style>#gform_wrapper_1[data-form-index=\"0\"].gform-theme,[data-parent-form=\"1_0\"]{--gf-color-primary: #204ce5;--gf-color-primary-rgb: 32, 76, 229;--gf-color-primary-contrast: #fff;--gf-color-primary-contrast-rgb: 255, 255, 255;--gf-color-primary-darker: #001AB3;--gf-color-primary-lighter: #527EFF;--gf-color-secondary: #fff;--gf-color-secondary-rgb: 255, 255, 255;--gf-color-secondary-contrast: #112337;--gf-color-secondary-contrast-rgb: 17, 35, 55;--gf-color-secondary-darker: #F5F5F5;--gf-color-secondary-lighter: #FFFFFF;--gf-color-out-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-out-ctrl-light-rgb: 17, 35, 55;--gf-color-out-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-out-ctrl-light-lighter: #F5F5F5;--gf-color-out-ctrl-dark: #585e6a;--gf-color-out-ctrl-dark-rgb: 88, 94, 106;--gf-color-out-ctrl-dark-darker: #112337;--gf-color-out-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-color-in-ctrl: #fff;--gf-color-in-ctrl-rgb: 255, 255, 255;--gf-color-in-ctrl-contrast: #112337;--gf-color-in-ctrl-contrast-rgb: 17, 35, 55;--gf-color-in-ctrl-darker: #F5F5F5;--gf-color-in-ctrl-lighter: #FFFFFF;--gf-color-in-ctrl-primary: #204ce5;--gf-color-in-ctrl-primary-rgb: 32, 76, 229;--gf-color-in-ctrl-primary-contrast: #fff;--gf-color-in-ctrl-primary-contrast-rgb: 255, 255, 255;--gf-color-in-ctrl-primary-darker: #001AB3;--gf-color-in-ctrl-primary-lighter: #527EFF;--gf-color-in-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-in-ctrl-light-rgb: 17, 35, 55;--gf-color-in-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-in-ctrl-light-lighter: #F5F5F5;--gf-color-in-ctrl-dark: #585e6a;--gf-color-in-ctrl-dark-rgb: 88, 94, 106;--gf-color-in-ctrl-dark-darker: #112337;--gf-color-in-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-radius: 3px;--gf-font-size-secondary: 14px;--gf-font-size-tertiary: 13px;--gf-icon-ctrl-number: url(\"data:image\/svg+xml,%3Csvg width='8' height='14' viewBox='0 0 8 14' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M4 0C4.26522 5.96046e-08 4.51957 0.105357 4.70711 0.292893L7.70711 3.29289C8.09763 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0.292893C10.0976 0.683417 10.0976 1.31658 9.70711 1.70711L5.70711 5.70711C5.31658 6.09763 4.68342 6.09763 4.29289 5.70711L0.292893 1.70711C-0.0976311 1.31658 -0.0976311 0.683418 0.292893 0.292893Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-search: url(\"data:image\/svg+xml,%3Csvg width='640' height='640' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath d='M256 128c-70.692 0-128 57.308-128 128 0 70.691 57.308 128 128 128 70.691 0 128-57.309 128-128 0-70.692-57.309-128-128-128zM64 256c0-106.039 85.961-192 192-192s192 85.961 192 192c0 41.466-13.146 79.863-35.498 111.248l154.125 154.125c12.496 12.496 12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Test Filum<\/h2>\n                            <p class='gform_description'><\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/cn\/wp-json\/wp\/v2\/pages\/51271' data-formid='1' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_25\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_25'>X\/Twitter<\/label><div class='ginput_container'><input name='input_25' id='input_1_25' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_1_25'>\u8fd9\u4e2a\u5b57\u6bb5\u662f\u7528\u4e8e\u9a8c\u8bc1\u76ee\u7684\uff0c\u5e94\u8be5\u4fdd\u6301\u4e0d\u53d8\u3002<\/div><\/div><div id=\"field_1_1\" class=\"gfield gfield--type-text gfield--input-type-text 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_1_1'>\u59d3\u540d<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_1_1' type='text' value='' class='large'    placeholder='\u59d3\u540d' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_10\" 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_1_10'>\u90ae\u7bb1<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_10' id='input_1_10' type='email' value='' class='large'   placeholder='\u90ae\u7bb1' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_1_11\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_11'>\u6027\u522b<\/label><div class='ginput_container ginput_container_select'><select name='input_11' id='input_1_11' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>\u6027\u522b<\/option><option value='Femenino' >\u5973<\/option><option value='Masculino' >\u7537<\/option><\/select><\/div><\/div><div id=\"field_1_12\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_12'>\u5e74\u7eaa<\/label><div class='ginput_container ginput_container_select'><select name='input_12' id='input_1_12' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>\u5e74\u7eaa<\/option><option value='Menor de 16 a\u00f1os' >16\u5c81\u4ee5\u4e0b<\/option><option value='Entre 16 y 30 a\u00f1os' >16-30\u5c81<\/option><option value='Entre 31 y 45 a\u00f1os' >31-45\u5c81<\/option><option value='Entre 46 y 59 a\u00f1os' >46-59\u5c81<\/option><option value='M\u00e1s de 60 a\u00f1os' >60\u5c81\u4ee5\u4e0a<\/option><\/select><\/div><\/div><fieldset id=\"field_1_21\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent 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' >* \u7528\u6237\u5e94\u4ed4\u7ec6\u9605\u8bfb\u5e76\u70b9\u51fb\u201c\u540c\u610f\u201d\u5176\u6761\u6b3e\u3002<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_21.1' id='input_1_21_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_1_21_1' ><a target=\u201d_blank\u201d href=\"https:\/\/institutchiaribcn.com\/cn\/legal-notice\/\">\u6211\u540c\u610f\u5e76\u63a5\u53d7\u6b27\u76df\u4e2a\u4eba\u6570\u636e\u4fdd\u62a4\u6cd5\u7b2c2016\/679\u6761\u6b3e<\/a><\/label><input type='hidden' name='input_21.2' value='&lt;a target=\u201d_blank\u201d href=&quot;https:\/\/institutchiaribcn.com\/cn\/legal-notice\/&quot;&gt;\u6211\u540c\u610f\u5e76\u63a5\u53d7\u6b27\u76df\u4e2a\u4eba\u6570\u636e\u4fdd\u62a4\u6cd5\u7b2c2016\/679\u6761\u6b3e&lt;\/a&gt;' class='gform_hidden' \/><input type='hidden' name='input_21.3' value='1' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_1_4\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class=\"icseb-section\">\r\n    <h2>\u4e2a\u4eba\u75c5\u53f2<\/h2>\r\n<\/div>\r\n<p class=\"icseb-section-text\"><strong>\u4f60\u66fe\u88ab\u8bca\u65ad\u51fa\u4e0b\u5217\u54ea\u4e9b\u75be\u75c5\u5417\uff1f<\/strong><\/p><\/div><fieldset id=\"field_1_6\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Antecedentes personales<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_6'><div class='gchoice gchoice_1_6_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.1' type='checkbox'  value='200'  id='choice_1_6_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_1' id='label_1_6_1' class='gform-field-label gform-field-label--type-inline'>\u5c0f\u8111\u6241\u6843\u4f53\u4e0b\u759d\u7b2c\u4e00\u578b<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_6_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.2' type='checkbox'  value='600'  id='choice_1_6_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_2' id='label_1_6_2' class='gform-field-label gform-field-label--type-inline'>\u539f\u53d1\u6027\u810a\u9ad3\u7a7a\u6d1e\u75c7<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_6_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.3' type='checkbox'  value='200'  id='choice_1_6_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_3' id='label_1_6_3' class='gform-field-label gform-field-label--type-inline'>\u9885\u5e95\u51f9\u9677\u3001\u9885\u5e95\u6241\u5e73\u3001\u9f7f\u58ee\u51f8\u7578\u5f62\u3001\u8111\u5e72\u626d\u7ed3\u75c7\u3001\u591c\u5c3f\u75c7<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_6_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.4' type='checkbox'  value='100'  id='choice_1_6_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_4' id='label_1_6_4' class='gform-field-label gform-field-label--type-inline'>\u539f\u53d1\u6027\u810a\u67f1\u4fa7\u5f2f<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_6_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.5' type='checkbox'  value='10'  id='choice_1_6_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_5' id='label_1_6_5' class='gform-field-label gform-field-label--type-inline'>\u690e\u95f4\u76d8\u7a81\u51fa\u75c7<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_6_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.6' type='checkbox'  value='10'  id='choice_1_6_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_6' id='label_1_6_6' class='gform-field-label gform-field-label--type-inline'>\u810a\u67f1\u4fa7\u5f2f<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_6_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.7' type='checkbox'  value='0'  id='choice_1_6_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_7' id='label_1_6_7' class='gform-field-label gform-field-label--type-inline'>\u5176\u4ed6\u75be\u75c5\uff1a<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_7\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_7'>txtOtrosDiagnosticos<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_7' id='input_1_7' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_1_19\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class=\"icseb-section\">\r\n    <h2>\u5bb6\u65cf\u75c5\u53f2\uff1a<\/h2>\r\n<\/div>\r\n<p class=\"icseb-section-text\"><strong>\u4f60\u7236\u6bcd\u4eb2\u6216\u5176\u4ed6\u76f4\u7cfb\u4eb2\u5c5e\u66fe\u88ab\u8bca\u65ad\u51fa\u4e0b\u5217\u54ea\u4e9b\u75be\u75c5\u5417\uff1f<\/strong><\/p><\/div><fieldset id=\"field_1_20\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Antecedentes familiares<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_20'><div class='gchoice gchoice_1_20_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.1' type='checkbox'  value='4'  id='choice_1_20_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_20_1' id='label_1_20_1' class='gform-field-label gform-field-label--type-inline'>\u5c0f\u8111\u6241\u6843\u4f53\u4e0b\u759d\u7b2c\u4e00\u578b<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_20_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.2' type='checkbox'  value='4'  id='choice_1_20_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_20_2' id='label_1_20_2' class='gform-field-label gform-field-label--type-inline'>\u539f\u53d1\u6027\u810a\u9ad3\u7a7a\u6d1e\u75c7<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_20_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.3' type='checkbox'  value='4'  id='choice_1_20_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_20_3' id='label_1_20_3' class='gform-field-label gform-field-label--type-inline'>\u539f\u53d1\u6027\u810a\u67f1\u4fa7\u5f2f<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_13\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class=\"icseb-section\">\r\n    <h2>\u75c7\u72b6<\/h2>\r\n<\/div>\r\n<p class=\"icseb-section-text\"><strong>\u4f60\u8eab\u4f53\u54ea\u4e9b\u90e8\u4f4d\u6709\u75bc\u75db\u5417\uff1f<\/strong><\/p><\/div><fieldset id=\"field_1_16\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >S\u00edntomas<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_16'><div class='gchoice gchoice_1_16_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.1' type='checkbox'  value='2'  id='choice_1_16_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_16_1' id='label_1_16_1' class='gform-field-label gform-field-label--type-inline'>\u5934\u90e8<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_16_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.2' type='checkbox'  value='2'  id='choice_1_16_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_16_2' id='label_1_16_2' class='gform-field-label gform-field-label--type-inline'>\u540e\u9888\u90e8<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_16_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.3' type='checkbox'  value='2'  id='choice_1_16_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_16_3' id='label_1_16_3' class='gform-field-label gform-field-label--type-inline'>\u8116\u5b50<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_16_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.4' type='checkbox'  value='1'  id='choice_1_16_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_16_4' id='label_1_16_4' class='gform-field-label gform-field-label--type-inline'>\u4e0a\u80cc\u90e8<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_16_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.5' type='checkbox'  value='1'  id='choice_1_16_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_16_5' id='label_1_16_5' class='gform-field-label gform-field-label--type-inline'>\u4e0b\u80cc\u90e8<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_16_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.6' type='checkbox'  value='2'  id='choice_1_16_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_16_6' id='label_1_16_6' class='gform-field-label gform-field-label--type-inline'>\u5c3e\u9aa8<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_16_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.7' type='checkbox'  value='1'  id='choice_1_16_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_16_7' id='label_1_16_7' class='gform-field-label gform-field-label--type-inline'>\u4e0a\u80a2<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_16_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.8' type='checkbox'  value='1'  id='choice_1_16_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_16_8' id='label_1_16_8' class='gform-field-label gform-field-label--type-inline'>\u4e0b\u80a2<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_15\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p class=\"icseb-section-text\"><strong>\u4f60\u6709\u4e0b\u5217\u54ea\u4e9b\u75c7\u72b6\u5417\uff1f<\/strong><\/p><\/div><fieldset id=\"field_1_14\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >S\u00edntomas2<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_14'><div class='gchoice gchoice_1_14_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.1' type='checkbox'  value='2'  id='choice_1_14_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_14_1' id='label_1_14_1' class='gform-field-label gform-field-label--type-inline'>\u8eab\u4f53\u67d0\u4e9b\u90e8\u4f4d\u6709\u9ebb\u6728<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_14_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.2' type='checkbox'  value='1'  id='choice_1_14_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_14_2' id='label_1_14_2' class='gform-field-label gform-field-label--type-inline'>\u6076\u5fc3\u5934\u6655<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_14_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.3' type='checkbox'  value='2'  id='choice_1_14_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_14_3' id='label_1_14_3' class='gform-field-label gform-field-label--type-inline'>\u6655\u7729<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_14_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.4' type='checkbox'  value='2'  id='choice_1_14_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_14_4' id='label_1_14_4' class='gform-field-label gform-field-label--type-inline'>\u7ad9\u7740\u65f6\u6216\u8d70\u8def\u65f6\u611f\u89c9\u4e0d\u7a33<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_14_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.5' type='checkbox'  value='2'  id='choice_1_14_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_14_5' id='label_1_14_5' class='gform-field-label gform-field-label--type-inline'>\u541e\u54bd\u6db2\u4f53\u6216\u56fa\u4f53\u98df\u7269\u6709\u56f0\u96be\uff0c\u611f\u89c9\u5589\u5499\u6709\u8282<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_14_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.6' type='checkbox'  value='2'  id='choice_1_14_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_14_6' id='label_1_14_6' class='gform-field-label gform-field-label--type-inline'>\u660f\u53a5<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_14_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.7' type='checkbox'  value='1'  id='choice_1_14_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_14_7' id='label_1_14_7' class='gform-field-label gform-field-label--type-inline'>\u7761\u7720\u95ee\u9898<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_14_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.8' type='checkbox'  value='2'  id='choice_1_14_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_14_8' id='label_1_14_8' class='gform-field-label gform-field-label--type-inline'>\u6613\u75b2\u52b3<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_14_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.9' type='checkbox'  value='1'  id='choice_1_14_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_14_9' id='label_1_14_9' class='gform-field-label gform-field-label--type-inline'>\u884c\u52a8\u56f0\u96be<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_14_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.11' type='checkbox'  value='2'  id='choice_1_14_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_14_11' id='label_1_14_11' class='gform-field-label gform-field-label--type-inline'>\u8eab\u4f53\u67d0\u4e2a\u90e8\u4f4d\u5bf9\u75bc\u75db\u6216\u78b0\u89e6\u611f\u89c9\u4e0d\u7075\u654f\u6216\u6ca1\u6709\u611f\u89c9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_14_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.12' type='checkbox'  value='4'  id='choice_1_14_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_14_12' id='label_1_14_12' class='gform-field-label gform-field-label--type-inline'>\u8eab\u4f53\u67d0\u4e2a\u90e8\u4f4d\u5bf9\u6e29\u5ea6\u611f\u89c9\u4e0d\u7075\u654f\u6216\u6ca1\u6709\u611f\u89c9<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_17\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p class=\"icseb-section-text\"><strong>\u4f60\u6709\u4e0b\u5217\u95ee\u9898\u5417\uff1f<\/strong><\/p><\/div><fieldset id=\"field_1_18\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Dificultades<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_18'><div class='gchoice gchoice_1_18_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.1' type='checkbox'  value='2'  id='choice_1_18_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_18_1' id='label_1_18_1' class='gform-field-label gform-field-label--type-inline'>\u6ce8\u610f\u529b\u95ee\u9898<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_18_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.2' type='checkbox'  value='2'  id='choice_1_18_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_18_2' id='label_1_18_2' class='gform-field-label gform-field-label--type-inline'>\u8bb0\u5fc6\u529b\u95ee\u9898<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_18_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.3' type='checkbox'  value='1'  id='choice_1_18_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_18_3' id='label_1_18_3' class='gform-field-label gform-field-label--type-inline'>\u53e3\u8bed\u8868\u8fbe\u80fd\u529b\u95ee\u9898<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_8\" class=\"gfield gfield--type-number gfield--input-type-number gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_8'>N\u00famero<\/label><div class='ginput_container ginput_container_number'><input name='input_8' id='input_1_8' type='text' step='any'   value='' class='large gform-text-input-reset'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_1_22\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_22'>Valoracion<\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_1_22' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_24\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_24'>Email destinatario Chiari<\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_1_24' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_1' class='gform_button button' 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