{"id":131,"date":"2016-03-11T10:20:35","date_gmt":"2016-03-11T08:20:35","guid":{"rendered":"http:\/\/policlinica-amaradia.ro\/?page_id=131"},"modified":"2020-09-03T13:06:22","modified_gmt":"2020-09-03T10:06:22","slug":"chestionar-pacienti","status":"publish","type":"page","link":"https:\/\/policlinica-amaradia.ro\/?page_id=131","title":{"rendered":"CHESTIONAR PACIENTI"},"content":{"rendered":"<div class=\"caldera-grid\" id=\"caldera_form_1\" data-cf-ver=\"1.9.6\" data-cf-form-id=\"CF5f50badb8318a\"><div id=\"caldera_notices_1\" data-spinner=\"https:\/\/policlinica-amaradia.ro\/wp-admin\/images\/spinner.gif\"><\/div><form data-instance=\"1\" class=\"CF5f50badb8318a caldera_forms_form cfajax-trigger\" method=\"POST\" enctype=\"multipart\/form-data\" id=\"CF5f50badb8318a_1\" data-form-id=\"CF5f50badb8318a\" aria-label=\"CHESTIONAR PACIENTI\" data-target=\"#caldera_notices_1\" data-template=\"#cfajax_CF5f50badb8318a-tmpl\" data-cfajax=\"CF5f50badb8318a\" data-load-element=\"_parent\" data-load-class=\"cf_processing\" data-post-disable=\"0\" data-action=\"cf_process_ajax_submit\" data-request=\"https:\/\/policlinica-amaradia.ro\/?cf_api=CF5f50badb8318a\" data-hiderows=\"true\">\r\n<input type=\"hidden\" id=\"_cf_verify_CF5f50badb8318a\" name=\"_cf_verify\" value=\"f8626d38f0\"  data-nonce-time=\"1776565823\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F131\" \/><div id=\"cf2-CF5f50badb8318a_1\"><\/div><input type=\"hidden\" name=\"_cf_frm_id\" value=\"CF5f50badb8318a\">\r\n<input type=\"hidden\" name=\"_cf_frm_ct\" value=\"1\">\r\n<input type=\"hidden\" name=\"cfajax\" value=\"CF5f50badb8318a\">\r\n<input type=\"hidden\" name=\"_cf_cr_pst\" value=\"131\">\r\n<div class=\"hide\" style=\"display:none; overflow:hidden;height:0;width:0;\">\r\n<label>Company<\/label><input type=\"text\" name=\"company\" value=\"\" autocomplete=\"off\">\r\n<\/div><div id=\"CF5f50badb8318a_1-row-1\"  class=\"row  first_row\"><div  class=\"col-sm-12  single\"><div class=\"\"><h2>Chestionar satisfactie pacienti<\/h2>\n<p>Va rugam sa completati formularul de mai jos<\/p>\n<p>Campurile cu * sunt obligatorii<\/p>\n<\/div><\/div><\/div><div id=\"CF5f50badb8318a_1-row-2\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_6638001\" class=\"form-group\" id=\"fld_6638001_1-wrap\">\r\n\t<label id=\"fld_6638001Label\" for=\"fld_6638001_1\" class=\"control-label\">Nume <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input   required type=\"text\" data-field=\"fld_6638001\" class=\" form-control\" id=\"fld_6638001_1\" name=\"fld_6638001\" value=\"\" data-type=\"text\" aria-required=\"true\"   aria-labelledby=\"fld_6638001Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_2516929\" class=\"form-group\" id=\"fld_2516929_1-wrap\">\r\n\t<label id=\"fld_2516929Label\" for=\"fld_2516929_1\" class=\"control-label\">Email <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input   required type=\"email\" data-field=\"fld_2516929\" class=\" form-control\" id=\"fld_2516929_1\" name=\"fld_2516929\" value=\"\" data-type=\"email\" aria-required=\"true\"   aria-labelledby=\"fld_2516929Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-6  last_col\"><div data-field-wrapper=\"fld_6763137\" class=\"form-group\" id=\"fld_6763137_1-wrap\">\r\n\t<label id=\"fld_6763137Label\" for=\"fld_6763137_1\" class=\"control-label\">Prenume <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input   required type=\"text\" data-field=\"fld_6763137\" class=\" form-control\" id=\"fld_6763137_1\" name=\"fld_6763137\" value=\"\" data-type=\"text\" aria-required=\"true\"   aria-labelledby=\"fld_6763137Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_7545970\" class=\"form-group\" id=\"fld_7545970_1-wrap\">\r\n\t<label id=\"fld_7545970Label\" for=\"fld_7545970_1\" class=\"control-label\">Telefon <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input  data-inputmask=\"'mask': '(999)999-9999'\"  required type=\"phone\" data-field=\"fld_7545970\" class=\" form-control\" id=\"fld_7545970_1\" name=\"fld_7545970\" value=\"\" data-type=\"phone\" aria-required=\"true\"   aria-labelledby=\"fld_7545970Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5f50badb8318a_1-row-3\"  class=\"row \"><div  class=\"col-sm-12  single\">\n<div data-field-wrapper=\"fld_6633118\" class=\"form-group\" id=\"fld_6633118_1-wrap\">\r\n\t<label id=\"fld_6633118Label\" for=\"fld_6633118_1\" class=\"control-label\">Data<\/label>\r\n\t<div class=\"\">\r\n\t\t<input  type=\"text\" data-provide=\"cfdatepicker\" name=\"fld_6633118\" value=\"2016-03-11 10:20:35\" id=\"fld_6633118_1\" data-field=\"fld_6633118\" class=\"form-control cfdatepicker is-cfdatepicker\" data-date-format=\"yyyy-mm-dd\" data-date-start-view=\"month\"   aria-labelledby=\"fld_6633118Label\"   \/>\n\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5f50badb8318a_1-row-4\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_577338\" class=\"form-group\" id=\"fld_577338_1-wrap\">\r\n<label id=\"fld_577338Label\" for=\"fld_577338_1\" class=\"control-label\">Ati mai fost la investigatii in cabinetele sau laboratorul policlinicii noastre?<\/label>\r\n<div class=\"\">\r\n\t\t\t\t\t<div class=\"radio\">\n\t\t\t\t<label data-label=\"DA\" for=\"fld_577338_1_opt390421\"><input type=\"radio\" id=\"fld_577338_1_opt390421\" data-field=\"fld_577338\" class=\"fld_577338_1\" name=\"fld_577338\" value=\"DA\"    data-radio-field=\"fld_577338_1\" data-type=\"radio\" data-calc-value=\"DA\" \/>\n\t\t\tDA\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"radio\">\n\t\t\t\t<label data-label=\"NU\" for=\"fld_577338_1_opt1215959\"><input type=\"radio\" id=\"fld_577338_1_opt1215959\" data-field=\"fld_577338\" class=\"fld_577338_1\" name=\"fld_577338\" value=\"NU\"    data-radio-field=\"fld_577338_1\" data-type=\"radio\" data-calc-value=\"NU\" \/>\n\t\t\tNU\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5f50badb8318a_1-row-5\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_5745977\" class=\"form-group\" id=\"fld_5745977_1-wrap\">\r\n<label id=\"fld_5745977Label\" for=\"fld_5745977_1\" class=\"control-label\">Daca da, cu ce frecventa?<\/label>\r\n<div class=\"\">\r\n\t\t\t\t\t<div class=\"radio\">\n\t\t\t\t<label data-label=\"O singura data\" for=\"fld_5745977_1_opt572161\"><input type=\"radio\" id=\"fld_5745977_1_opt572161\" data-field=\"fld_5745977\" class=\"fld_5745977_1\" name=\"fld_5745977\" value=\"O singura data\"    data-radio-field=\"fld_5745977_1\" data-type=\"radio\" data-calc-value=\"O singura data\" \/>\n\t\t\tO singura data\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"radio\">\n\t\t\t\t<label data-label=\"De mai multe ori\" for=\"fld_5745977_1_opt1781791\"><input type=\"radio\" id=\"fld_5745977_1_opt1781791\" data-field=\"fld_5745977\" class=\"fld_5745977_1\" name=\"fld_5745977\" value=\"De mai multe ori\"    data-radio-field=\"fld_5745977_1\" data-type=\"radio\" data-calc-value=\"De mai multe ori\" \/>\n\t\t\tDe mai multe ori\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-6  last_col\"><div data-field-wrapper=\"fld_6074664\" class=\"form-group\" id=\"fld_6074664_1-wrap\">\r\n<label id=\"fld_6074664Label\" for=\"fld_6074664_1\" class=\"control-label\">Daca nu ati mai fost, care a fost motivul?<\/label>\r\n<div class=\"\">\r\n\t\t\t\t\t<div class=\"radio\">\n\t\t\t\t<label data-label=\"Nu am avut nevoie\" for=\"fld_6074664_1_opt710695\"><input type=\"radio\" id=\"fld_6074664_1_opt710695\" data-field=\"fld_6074664\" class=\"fld_6074664_1\" name=\"fld_6074664\" value=\"Nu am avut nevoie\"    data-radio-field=\"fld_6074664_1\" data-type=\"radio\" data-calc-value=\"Nu am avut nevoie\" \/>\n\t\t\tNu am avut nevoie\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"radio\">\n\t\t\t\t<label data-label=\"Nu am stiut\" for=\"fld_6074664_1_opt1966225\"><input type=\"radio\" id=\"fld_6074664_1_opt1966225\" data-field=\"fld_6074664\" class=\"fld_6074664_1\" name=\"fld_6074664\" value=\"Nu am stiut\"    data-radio-field=\"fld_6074664_1\" data-type=\"radio\" data-calc-value=\"Nu am stiut\" \/>\n\t\t\tNu am stiut\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"radio\">\n\t\t\t\t<label data-label=\"Nu am fost trimis aici\" for=\"fld_6074664_1_opt2315623\"><input type=\"radio\" id=\"fld_6074664_1_opt2315623\" data-field=\"fld_6074664\" class=\"fld_6074664_1\" name=\"fld_6074664\" value=\"Nu am fost trimis aici\"    data-radio-field=\"fld_6074664_1\" data-type=\"radio\" data-calc-value=\"Nu am fost trimis aici\" \/>\n\t\t\tNu am fost trimis aici\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5f50badb8318a_1-row-6\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_191633\" class=\"form-group\" id=\"fld_191633_1-wrap\">\r\n<label id=\"fld_191633Label\" for=\"fld_191633_1\" class=\"control-label\">Cat timp a trebuit sa asteptati de la ora programata pentru investigatie pana la efectuarea investigatiei?<\/label>\r\n<div class=\"\">\r\n\t\t\t\t\t<div class=\"radio\">\n\t\t\t\t<label data-label=\"Mai putin de jumatate de ora\" for=\"fld_191633_1_opt997032\"><input type=\"radio\" id=\"fld_191633_1_opt997032\" data-field=\"fld_191633\" class=\"fld_191633_1\" name=\"fld_191633\" value=\"Mai putin de jumatate de ora\"    data-radio-field=\"fld_191633_1\" data-type=\"radio\" data-calc-value=\"Mai putin de jumatate de ora\" \/>\n\t\t\tMai putin de jumatate de ora\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"radio\">\n\t\t\t\t<label data-label=\"Mai mult de jumatate de ora\" for=\"fld_191633_1_opt1534812\"><input type=\"radio\" id=\"fld_191633_1_opt1534812\" data-field=\"fld_191633\" class=\"fld_191633_1\" name=\"fld_191633\" value=\"Mai mult de jumatate de ora\"    data-radio-field=\"fld_191633_1\" data-type=\"radio\" data-calc-value=\"Mai mult de jumatate de ora\" \/>\n\t\t\tMai mult de jumatate de ora\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"radio\">\n\t\t\t\t<label data-label=\"Mai mult de o ora \" for=\"fld_191633_1_opt3102707\"><input type=\"radio\" id=\"fld_191633_1_opt3102707\" data-field=\"fld_191633\" class=\"fld_191633_1\" name=\"fld_191633\" value=\"Mai mult de o ora \"    data-radio-field=\"fld_191633_1\" data-type=\"radio\" data-calc-value=\"Mai mult de o ora \" \/>\n\t\t\tMai mult de o ora \t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"radio\">\n\t\t\t\t<label data-label=\"Mai multe ore\" for=\"fld_191633_1_opt3733820\"><input type=\"radio\" id=\"fld_191633_1_opt3733820\" data-field=\"fld_191633\" class=\"fld_191633_1\" name=\"fld_191633\" value=\"Mai multe ore\"    data-radio-field=\"fld_191633_1\" data-type=\"radio\" data-calc-value=\"Mai multe ore\" \/>\n\t\t\tMai multe ore\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_7150516\" class=\"form-group\" id=\"fld_7150516_1-wrap\">\r\n<label id=\"fld_7150516Label\" for=\"fld_7150516_1\" class=\"control-label\">Curatenia din cabinet (acordati puncte de la 1 la 5):<\/label>\r\n<div class=\"\">\r\n\t\t\t\t<label class=\"radio-inline\" data-label=\"1\" for=\"fld_7150516_1_opt640860\"><input type=\"radio\" id=\"fld_7150516_1_opt640860\" data-field=\"fld_7150516\" class=\"fld_7150516_1\" name=\"fld_7150516\" value=\"1\"    data-radio-field=\"fld_7150516_1\" data-type=\"radio\" data-calc-value=\"1\" \/>\n\t\t\t1\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"2\" for=\"fld_7150516_1_opt1282067\"><input type=\"radio\" id=\"fld_7150516_1_opt1282067\" data-field=\"fld_7150516\" class=\"fld_7150516_1\" name=\"fld_7150516\" value=\"2\"    data-radio-field=\"fld_7150516_1\" data-type=\"radio\" data-calc-value=\"2\" \/>\n\t\t\t2\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"3\" for=\"fld_7150516_1_opt2599211\"><input type=\"radio\" id=\"fld_7150516_1_opt2599211\" data-field=\"fld_7150516\" class=\"fld_7150516_1\" name=\"fld_7150516\" value=\"3\"    data-radio-field=\"fld_7150516_1\" data-type=\"radio\" data-calc-value=\"3\" \/>\n\t\t\t3\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"4\" for=\"fld_7150516_1_opt3531581\"><input type=\"radio\" id=\"fld_7150516_1_opt3531581\" data-field=\"fld_7150516\" class=\"fld_7150516_1\" name=\"fld_7150516\" value=\"4\"    data-radio-field=\"fld_7150516_1\" data-type=\"radio\" data-calc-value=\"4\" \/>\n\t\t\t4\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"5\" for=\"fld_7150516_1_opt5204032\"><input type=\"radio\" id=\"fld_7150516_1_opt5204032\" data-field=\"fld_7150516\" class=\"fld_7150516_1\" name=\"fld_7150516\" value=\"5\"    data-radio-field=\"fld_7150516_1\" data-type=\"radio\" data-calc-value=\"5\" \/>\n\t\t\t5\t\t<\/label>\n\t\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_6359445\" class=\"form-group\" id=\"fld_6359445_1-wrap\">\r\n<label id=\"fld_6359445Label\" for=\"fld_6359445_1\" class=\"control-label\">Iluminarea din cabinet (acordati puncte de la 1 la 5):<\/label>\r\n<div class=\"\">\r\n\t\t\t\t<label class=\"radio-inline\" data-label=\"1\" for=\"fld_6359445_1_opt318264\"><input type=\"radio\" id=\"fld_6359445_1_opt318264\" data-field=\"fld_6359445\" class=\"fld_6359445_1\" name=\"fld_6359445\" value=\"1\"    data-radio-field=\"fld_6359445_1\" data-type=\"radio\" data-calc-value=\"1\" \/>\n\t\t\t1\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"2\" for=\"fld_6359445_1_opt1480448\"><input type=\"radio\" id=\"fld_6359445_1_opt1480448\" data-field=\"fld_6359445\" class=\"fld_6359445_1\" name=\"fld_6359445\" value=\"2\"    data-radio-field=\"fld_6359445_1\" data-type=\"radio\" data-calc-value=\"2\" \/>\n\t\t\t2\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"3\" for=\"fld_6359445_1_opt2118621\"><input type=\"radio\" id=\"fld_6359445_1_opt2118621\" data-field=\"fld_6359445\" class=\"fld_6359445_1\" name=\"fld_6359445\" value=\"3\"    data-radio-field=\"fld_6359445_1\" data-type=\"radio\" data-calc-value=\"3\" \/>\n\t\t\t3\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"4\" for=\"fld_6359445_1_opt4141334\"><input type=\"radio\" id=\"fld_6359445_1_opt4141334\" data-field=\"fld_6359445\" class=\"fld_6359445_1\" name=\"fld_6359445\" value=\"4\"    data-radio-field=\"fld_6359445_1\" data-type=\"radio\" data-calc-value=\"4\" \/>\n\t\t\t4\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"5\" for=\"fld_6359445_1_opt4861927\"><input type=\"radio\" id=\"fld_6359445_1_opt4861927\" data-field=\"fld_6359445\" class=\"fld_6359445_1\" name=\"fld_6359445\" value=\"5\"    data-radio-field=\"fld_6359445_1\" data-type=\"radio\" data-calc-value=\"5\" \/>\n\t\t\t5\t\t<\/label>\n\t\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_3508279\" class=\"form-group\" id=\"fld_3508279_1-wrap\">\r\n<label id=\"fld_3508279Label\" for=\"fld_3508279_1\" class=\"control-label\">Temperatura din cabinet (acordati puncte de la 1 la 5):<\/label>\r\n<div class=\"\">\r\n\t\t\t\t<label class=\"radio-inline\" data-label=\"1\" for=\"fld_3508279_1_opt945842\"><input type=\"radio\" id=\"fld_3508279_1_opt945842\" data-field=\"fld_3508279\" class=\"fld_3508279_1\" name=\"fld_3508279\" value=\"1\"    data-radio-field=\"fld_3508279_1\" data-type=\"radio\" data-calc-value=\"1\" \/>\n\t\t\t1\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"2\" for=\"fld_3508279_1_opt1542926\"><input type=\"radio\" id=\"fld_3508279_1_opt1542926\" data-field=\"fld_3508279\" class=\"fld_3508279_1\" name=\"fld_3508279\" value=\"2\"    data-radio-field=\"fld_3508279_1\" data-type=\"radio\" data-calc-value=\"2\" \/>\n\t\t\t2\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"3\" for=\"fld_3508279_1_opt3024236\"><input type=\"radio\" id=\"fld_3508279_1_opt3024236\" data-field=\"fld_3508279\" class=\"fld_3508279_1\" name=\"fld_3508279\" value=\"3\"    data-radio-field=\"fld_3508279_1\" data-type=\"radio\" data-calc-value=\"3\" \/>\n\t\t\t3\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"4\" for=\"fld_3508279_1_opt3208663\"><input type=\"radio\" id=\"fld_3508279_1_opt3208663\" data-field=\"fld_3508279\" class=\"fld_3508279_1\" name=\"fld_3508279\" value=\"4\"    data-radio-field=\"fld_3508279_1\" data-type=\"radio\" data-calc-value=\"4\" \/>\n\t\t\t4\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"5\" for=\"fld_3508279_1_opt4881970\"><input type=\"radio\" id=\"fld_3508279_1_opt4881970\" data-field=\"fld_3508279\" class=\"fld_3508279_1\" name=\"fld_3508279\" value=\"5\"    data-radio-field=\"fld_3508279_1\" data-type=\"radio\" data-calc-value=\"5\" \/>\n\t\t\t5\t\t<\/label>\n\t\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_5580025\" class=\"form-group\" id=\"fld_5580025_1-wrap\">\r\n<label id=\"fld_5580025Label\" for=\"fld_5580025_1\" class=\"control-label\">Serviciile oferite la secretariat (acordati puncte de la 1 la 5):<\/label>\r\n<div class=\"\">\r\n\t\t\t\t<label class=\"radio-inline\" data-label=\"1\" for=\"fld_5580025_1_opt945842\"><input type=\"radio\" id=\"fld_5580025_1_opt945842\" data-field=\"fld_5580025\" class=\"fld_5580025_1\" name=\"fld_5580025\" value=\"1\"    data-radio-field=\"fld_5580025_1\" data-type=\"radio\" data-calc-value=\"1\" \/>\n\t\t\t1\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"2\" for=\"fld_5580025_1_opt1542926\"><input type=\"radio\" id=\"fld_5580025_1_opt1542926\" data-field=\"fld_5580025\" class=\"fld_5580025_1\" name=\"fld_5580025\" value=\"2\"    data-radio-field=\"fld_5580025_1\" data-type=\"radio\" data-calc-value=\"2\" \/>\n\t\t\t2\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"3\" for=\"fld_5580025_1_opt3024236\"><input type=\"radio\" id=\"fld_5580025_1_opt3024236\" data-field=\"fld_5580025\" class=\"fld_5580025_1\" name=\"fld_5580025\" value=\"3\"    data-radio-field=\"fld_5580025_1\" data-type=\"radio\" data-calc-value=\"3\" \/>\n\t\t\t3\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"4\" for=\"fld_5580025_1_opt3208663\"><input type=\"radio\" id=\"fld_5580025_1_opt3208663\" data-field=\"fld_5580025\" class=\"fld_5580025_1\" name=\"fld_5580025\" value=\"4\"    data-radio-field=\"fld_5580025_1\" data-type=\"radio\" data-calc-value=\"4\" \/>\n\t\t\t4\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"5\" for=\"fld_5580025_1_opt4881970\"><input type=\"radio\" id=\"fld_5580025_1_opt4881970\" data-field=\"fld_5580025\" class=\"fld_5580025_1\" name=\"fld_5580025\" value=\"5\"    data-radio-field=\"fld_5580025_1\" data-type=\"radio\" data-calc-value=\"5\" \/>\n\t\t\t5\t\t<\/label>\n\t\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_3846865\" class=\"form-group\" id=\"fld_3846865_1-wrap\">\r\n<label id=\"fld_3846865Label\" for=\"fld_3846865_1\" class=\"control-label\">Numarul locurilor din sala de asteptare (acordati puncte de la 1 la 5):<\/label>\r\n<div class=\"\">\r\n\t\t\t\t<label class=\"radio-inline\" data-label=\"1\" for=\"fld_3846865_1_opt945842\"><input type=\"radio\" id=\"fld_3846865_1_opt945842\" data-field=\"fld_3846865\" class=\"fld_3846865_1\" name=\"fld_3846865\" value=\"1\"    data-radio-field=\"fld_3846865_1\" data-type=\"radio\" data-calc-value=\"1\" \/>\n\t\t\t1\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"2\" for=\"fld_3846865_1_opt1542926\"><input type=\"radio\" id=\"fld_3846865_1_opt1542926\" data-field=\"fld_3846865\" class=\"fld_3846865_1\" name=\"fld_3846865\" value=\"2\"    data-radio-field=\"fld_3846865_1\" data-type=\"radio\" data-calc-value=\"2\" \/>\n\t\t\t2\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"3\" for=\"fld_3846865_1_opt3024236\"><input type=\"radio\" id=\"fld_3846865_1_opt3024236\" data-field=\"fld_3846865\" class=\"fld_3846865_1\" name=\"fld_3846865\" value=\"3\"    data-radio-field=\"fld_3846865_1\" data-type=\"radio\" data-calc-value=\"3\" \/>\n\t\t\t3\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"4\" for=\"fld_3846865_1_opt3208663\"><input type=\"radio\" id=\"fld_3846865_1_opt3208663\" data-field=\"fld_3846865\" class=\"fld_3846865_1\" name=\"fld_3846865\" value=\"4\"    data-radio-field=\"fld_3846865_1\" data-type=\"radio\" data-calc-value=\"4\" \/>\n\t\t\t4\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"5\" for=\"fld_3846865_1_opt4881970\"><input type=\"radio\" id=\"fld_3846865_1_opt4881970\" data-field=\"fld_3846865\" class=\"fld_3846865_1\" name=\"fld_3846865\" value=\"5\"    data-radio-field=\"fld_3846865_1\" data-type=\"radio\" data-calc-value=\"5\" \/>\n\t\t\t5\t\t<\/label>\n\t\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_1011238\" class=\"form-group\" id=\"fld_1011238_1-wrap\">\r\n<label id=\"fld_1011238Label\" for=\"fld_1011238_1\" class=\"control-label\">Starea grupurilor sanitare pentru pacienti (acordati puncte de la 1 la 5):<\/label>\r\n<div class=\"\">\r\n\t\t\t\t<label class=\"radio-inline\" data-label=\"1\" for=\"fld_1011238_1_opt945842\"><input type=\"radio\" id=\"fld_1011238_1_opt945842\" data-field=\"fld_1011238\" class=\"fld_1011238_1\" name=\"fld_1011238\" value=\"1\"    data-radio-field=\"fld_1011238_1\" data-type=\"radio\" data-calc-value=\"1\" \/>\n\t\t\t1\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"2\" for=\"fld_1011238_1_opt1542926\"><input type=\"radio\" id=\"fld_1011238_1_opt1542926\" data-field=\"fld_1011238\" class=\"fld_1011238_1\" name=\"fld_1011238\" value=\"2\"    data-radio-field=\"fld_1011238_1\" data-type=\"radio\" data-calc-value=\"2\" \/>\n\t\t\t2\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"3\" for=\"fld_1011238_1_opt3024236\"><input type=\"radio\" id=\"fld_1011238_1_opt3024236\" data-field=\"fld_1011238\" class=\"fld_1011238_1\" name=\"fld_1011238\" value=\"3\"    data-radio-field=\"fld_1011238_1\" data-type=\"radio\" data-calc-value=\"3\" \/>\n\t\t\t3\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"4\" for=\"fld_1011238_1_opt3208663\"><input type=\"radio\" id=\"fld_1011238_1_opt3208663\" data-field=\"fld_1011238\" class=\"fld_1011238_1\" name=\"fld_1011238\" value=\"4\"    data-radio-field=\"fld_1011238_1\" data-type=\"radio\" data-calc-value=\"4\" \/>\n\t\t\t4\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"5\" for=\"fld_1011238_1_opt4881970\"><input type=\"radio\" id=\"fld_1011238_1_opt4881970\" data-field=\"fld_1011238\" class=\"fld_1011238_1\" name=\"fld_1011238\" value=\"5\"    data-radio-field=\"fld_1011238_1\" data-type=\"radio\" data-calc-value=\"5\" \/>\n\t\t\t5\t\t<\/label>\n\t\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_1204114\" class=\"form-group\" id=\"fld_1204114_1-wrap\">\r\n<label id=\"fld_1204114Label\" for=\"fld_1204114_1\" class=\"control-label\">Cine v-a informat despre investigatia care urma sa vi se efectueze?<\/label>\r\n<div class=\"\">\r\n\t\t\t\t\t<div class=\"radio\">\n\t\t\t\t<label data-label=\"Medicul care v-a dat trimiterea\" for=\"fld_1204114_1_opt763373\"><input type=\"radio\" id=\"fld_1204114_1_opt763373\" data-field=\"fld_1204114\" class=\"fld_1204114_1\" name=\"fld_1204114\" value=\"Medicul care v-a dat trimiterea\"    data-radio-field=\"fld_1204114_1\" data-type=\"radio\" data-calc-value=\"Medicul care v-a dat trimiterea\" \/>\n\t\t\tMedicul care v-a dat trimiterea\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"radio\">\n\t\t\t\t<label data-label=\"Medicul care a efectuat investigatia\" for=\"fld_1204114_1_opt2013105\"><input type=\"radio\" id=\"fld_1204114_1_opt2013105\" data-field=\"fld_1204114\" class=\"fld_1204114_1\" name=\"fld_1204114\" value=\"Medicul care a efectuat investigatia\"    data-radio-field=\"fld_1204114_1\" data-type=\"radio\" data-calc-value=\"Medicul care a efectuat investigatia\" \/>\n\t\t\tMedicul care a efectuat investigatia\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"radio\">\n\t\t\t\t<label data-label=\"Asistenta\" for=\"fld_1204114_1_opt2192240\"><input type=\"radio\" id=\"fld_1204114_1_opt2192240\" data-field=\"fld_1204114\" class=\"fld_1204114_1\" name=\"fld_1204114\" value=\"Asistenta\"    data-radio-field=\"fld_1204114_1\" data-type=\"radio\" data-calc-value=\"Asistenta\" \/>\n\t\t\tAsistenta\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"radio\">\n\t\t\t\t<label data-label=\"Personalul din secretariat\" for=\"fld_1204114_1_opt3396112\"><input type=\"radio\" id=\"fld_1204114_1_opt3396112\" data-field=\"fld_1204114\" class=\"fld_1204114_1\" name=\"fld_1204114\" value=\"Personalul din secretariat\"    data-radio-field=\"fld_1204114_1\" data-type=\"radio\" data-calc-value=\"Personalul din secretariat\" \/>\n\t\t\tPersonalul din secretariat\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_6780090\" class=\"form-group\" id=\"fld_6780090_1-wrap\">\r\n<label id=\"fld_6780090Label\" for=\"fld_6780090_1\" class=\"control-label\">Inainte de a fi investigat vi s-a explicat cum decurge examinarea?<\/label>\r\n<div class=\"\">\r\n\t\t\t\t\t<div class=\"radio\">\n\t\t\t\t<label data-label=\"Am citit in informarea primita de la secretariat\" for=\"fld_6780090_1_opt617087\"><input type=\"radio\" id=\"fld_6780090_1_opt617087\" data-field=\"fld_6780090\" class=\"fld_6780090_1\" name=\"fld_6780090\" value=\"Am citit in informarea primita de la secretariat\"    data-radio-field=\"fld_6780090_1\" data-type=\"radio\" data-calc-value=\"Am citit in informarea primita de la secretariat\" \/>\n\t\t\tAm citit in informarea primita de la secretariat\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"radio\">\n\t\t\t\t<label data-label=\"Asistenta care efectua investigatia mi-a explicat\" for=\"fld_6780090_1_opt1503535\"><input type=\"radio\" id=\"fld_6780090_1_opt1503535\" data-field=\"fld_6780090\" class=\"fld_6780090_1\" name=\"fld_6780090\" value=\"Asistenta care efectua investigatia mi-a explicat\"    data-radio-field=\"fld_6780090_1\" data-type=\"radio\" data-calc-value=\"Asistenta care efectua investigatia mi-a explicat\" \/>\n\t\t\tAsistenta care efectua investigatia mi-a explicat\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"radio\">\n\t\t\t\t<label data-label=\"Medicul care a condus si a dat rezultatul mi-a explicat\" for=\"fld_6780090_1_opt2780004\"><input type=\"radio\" id=\"fld_6780090_1_opt2780004\" data-field=\"fld_6780090\" class=\"fld_6780090_1\" name=\"fld_6780090\" value=\"Medicul care a condus si a dat rezultatul mi-a explicat\"    data-radio-field=\"fld_6780090_1\" data-type=\"radio\" data-calc-value=\"Medicul care a condus si a dat rezultatul mi-a explicat\" \/>\n\t\t\tMedicul care a condus si a dat rezultatul mi-a explicat\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"radio\">\n\t\t\t\t<label data-label=\"Nimeni nu mi-a explicat\" for=\"fld_6780090_1_opt3492778\"><input type=\"radio\" id=\"fld_6780090_1_opt3492778\" data-field=\"fld_6780090\" class=\"fld_6780090_1\" name=\"fld_6780090\" value=\"Nimeni nu mi-a explicat\"    data-radio-field=\"fld_6780090_1\" data-type=\"radio\" data-calc-value=\"Nimeni nu mi-a explicat\" \/>\n\t\t\tNimeni nu mi-a explicat\t\t<\/label>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_6220234\" class=\"form-group\" id=\"fld_6220234_1-wrap\">\r\n<label id=\"fld_6220234Label\" for=\"fld_6220234_1\" class=\"control-label\">Raspunsurile primite au reusit sa va linisteasca?<\/label>\r\n<div class=\"\">\r\n\t\t\t\t<label class=\"radio-inline\" data-label=\"DA\" for=\"fld_6220234_1_opt677657\"><input type=\"radio\" id=\"fld_6220234_1_opt677657\" data-field=\"fld_6220234\" class=\"fld_6220234_1\" name=\"fld_6220234\" value=\"DA\"    data-radio-field=\"fld_6220234_1\" data-type=\"radio\" data-calc-value=\"DA\" \/>\n\t\t\tDA\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"NU\" for=\"fld_6220234_1_opt1832647\"><input type=\"radio\" id=\"fld_6220234_1_opt1832647\" data-field=\"fld_6220234\" class=\"fld_6220234_1\" name=\"fld_6220234\" value=\"NU\"    data-radio-field=\"fld_6220234_1\" data-type=\"radio\" data-calc-value=\"NU\" \/>\n\t\t\tNU\t\t<\/label>\n\t\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_503512\" class=\"form-group\" id=\"fld_503512_1-wrap\">\r\n<label id=\"fld_503512Label\" for=\"fld_503512_1\" class=\"control-label\">Considerati ca este necesara o informare amanuntita asupra investigatiilor?<\/label>\r\n<div class=\"\">\r\n\t\t\t\t<label class=\"radio-inline\" data-label=\"DA\" for=\"fld_503512_1_opt677657\"><input type=\"radio\" id=\"fld_503512_1_opt677657\" data-field=\"fld_503512\" class=\"fld_503512_1\" name=\"fld_503512\" value=\"DA\"    data-radio-field=\"fld_503512_1\" data-type=\"radio\" data-calc-value=\"DA\" \/>\n\t\t\tDA\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"NU\" for=\"fld_503512_1_opt1832647\"><input type=\"radio\" id=\"fld_503512_1_opt1832647\" data-field=\"fld_503512\" class=\"fld_503512_1\" name=\"fld_503512\" value=\"NU\"    data-radio-field=\"fld_503512_1\" data-type=\"radio\" data-calc-value=\"NU\" \/>\n\t\t\tNU\t\t<\/label>\n\t\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_9771813\" class=\"form-group\" id=\"fld_9771813_1-wrap\">\r\n<label id=\"fld_9771813Label\" for=\"fld_9771813_1\" class=\"control-label\">Sunteti multumit de activitatea medicilor nostri? (acordati puncte de la 1 la 5)<\/label>\r\n<div class=\"\">\r\n\t\t\t\t<label class=\"radio-inline\" data-label=\"1\" for=\"fld_9771813_1_opt434948\"><input type=\"radio\" id=\"fld_9771813_1_opt434948\" data-field=\"fld_9771813\" class=\"fld_9771813_1\" name=\"fld_9771813\" value=\"1\"    data-radio-field=\"fld_9771813_1\" data-type=\"radio\" data-calc-value=\"1\" \/>\n\t\t\t1\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"2\" for=\"fld_9771813_1_opt1952517\"><input type=\"radio\" id=\"fld_9771813_1_opt1952517\" data-field=\"fld_9771813\" class=\"fld_9771813_1\" name=\"fld_9771813\" value=\"2\"    data-radio-field=\"fld_9771813_1\" data-type=\"radio\" data-calc-value=\"2\" \/>\n\t\t\t2\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"3\" for=\"fld_9771813_1_opt2883559\"><input type=\"radio\" id=\"fld_9771813_1_opt2883559\" data-field=\"fld_9771813\" class=\"fld_9771813_1\" name=\"fld_9771813\" value=\"3\"    data-radio-field=\"fld_9771813_1\" data-type=\"radio\" data-calc-value=\"3\" \/>\n\t\t\t3\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"4\" for=\"fld_9771813_1_opt3257117\"><input type=\"radio\" id=\"fld_9771813_1_opt3257117\" data-field=\"fld_9771813\" class=\"fld_9771813_1\" name=\"fld_9771813\" value=\"4\"    data-radio-field=\"fld_9771813_1\" data-type=\"radio\" data-calc-value=\"4\" \/>\n\t\t\t4\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"5\" for=\"fld_9771813_1_opt4224321\"><input type=\"radio\" id=\"fld_9771813_1_opt4224321\" data-field=\"fld_9771813\" class=\"fld_9771813_1\" name=\"fld_9771813\" value=\"5\"    data-radio-field=\"fld_9771813_1\" data-type=\"radio\" data-calc-value=\"5\" \/>\n\t\t\t5\t\t<\/label>\n\t\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_1501846\" class=\"form-group\" id=\"fld_1501846_1-wrap\">\r\n<label id=\"fld_1501846Label\" for=\"fld_1501846_1\" class=\"control-label\">Sunteti multumit de activitatea asistentelor noastre? (acordati puncte de la 1 la 5)<\/label>\r\n<div class=\"\">\r\n\t\t\t\t<label class=\"radio-inline\" data-label=\"1\" for=\"fld_1501846_1_opt434948\"><input type=\"radio\" id=\"fld_1501846_1_opt434948\" data-field=\"fld_1501846\" class=\"fld_1501846_1\" name=\"fld_1501846\" value=\"1\"    data-radio-field=\"fld_1501846_1\" data-type=\"radio\" data-calc-value=\"1\" \/>\n\t\t\t1\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"2\" for=\"fld_1501846_1_opt1952517\"><input type=\"radio\" id=\"fld_1501846_1_opt1952517\" data-field=\"fld_1501846\" class=\"fld_1501846_1\" name=\"fld_1501846\" value=\"2\"    data-radio-field=\"fld_1501846_1\" data-type=\"radio\" data-calc-value=\"2\" \/>\n\t\t\t2\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"3\" for=\"fld_1501846_1_opt2883559\"><input type=\"radio\" id=\"fld_1501846_1_opt2883559\" data-field=\"fld_1501846\" class=\"fld_1501846_1\" name=\"fld_1501846\" value=\"3\"    data-radio-field=\"fld_1501846_1\" data-type=\"radio\" data-calc-value=\"3\" \/>\n\t\t\t3\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"4\" for=\"fld_1501846_1_opt3257117\"><input type=\"radio\" id=\"fld_1501846_1_opt3257117\" data-field=\"fld_1501846\" class=\"fld_1501846_1\" name=\"fld_1501846\" value=\"4\"    data-radio-field=\"fld_1501846_1\" data-type=\"radio\" data-calc-value=\"4\" \/>\n\t\t\t4\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"5\" for=\"fld_1501846_1_opt4224321\"><input type=\"radio\" id=\"fld_1501846_1_opt4224321\" data-field=\"fld_1501846\" class=\"fld_1501846_1\" name=\"fld_1501846\" value=\"5\"    data-radio-field=\"fld_1501846_1\" data-type=\"radio\" data-calc-value=\"5\" \/>\n\t\t\t5\t\t<\/label>\n\t\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_584573\" class=\"form-group\" id=\"fld_584573_1-wrap\">\r\n<label id=\"fld_584573Label\" for=\"fld_584573_1\" class=\"control-label\">Sexul dumneavoastra:<\/label>\r\n<div class=\"\">\r\n\t\t\t\t<label class=\"radio-inline\" data-label=\"Masculin\" for=\"fld_584573_1_opt674415\"><input type=\"radio\" id=\"fld_584573_1_opt674415\" data-field=\"fld_584573\" class=\"fld_584573_1\" name=\"fld_584573\" value=\"Masculin\"    data-radio-field=\"fld_584573_1\" data-type=\"radio\" data-calc-value=\"Masculin\" \/>\n\t\t\tMasculin\t\t<\/label>\n\t\t\t\t\t\t\t\t<label class=\"radio-inline\" data-label=\"Feminin\" for=\"fld_584573_1_opt1667898\"><input type=\"radio\" id=\"fld_584573_1_opt1667898\" data-field=\"fld_584573\" class=\"fld_584573_1\" name=\"fld_584573\" value=\"Feminin\"    data-radio-field=\"fld_584573_1\" data-type=\"radio\" data-calc-value=\"Feminin\" \/>\n\t\t\tFeminin\t\t<\/label>\n\t\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5f50badb8318a_1-row-7\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_4124862\" class=\"form-group\" id=\"fld_4124862_1-wrap\">\r\n\t<label id=\"fld_4124862Label\" for=\"fld_4124862_1\" class=\"control-label\">Acord <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"checkbox\">\n\t\t\t\t\n                <label                         for=\"fld_4124862_1_opt91138\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_4124862_1\" data-parsley-multiple=\"fld_4124862_1\"                                type=\"checkbox\"\n                                data-label=\"sunt de acord cu politica de confidentialitate\"\n                                data-field=\"fld_4124862\"\n                                id=\"fld_4124862_1_opt91138\"\n                                class=\"fld_4124862_1 option-required\"\n                                name=\"fld_4124862[opt91138]\"\n                                value=\"sunt de acord cu politica de confidentialitate\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_4124862_1\"\n                                                                data-calc-value=\"sunt de acord cu politica de confidentialitate\"\n                            >\n                    sunt de acord cu politica de confidentialitate                <\/label>\n\n                \t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"checkbox\">\n\t\t\t\t\n                <label                         for=\"fld_4124862_1_opt1190483\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_4124862_1\" data-parsley-multiple=\"fld_4124862_1\"                                type=\"checkbox\"\n                                data-label=\"declar ca datele introduse sunt reale si pot dovedi asta\"\n                                data-field=\"fld_4124862\"\n                                id=\"fld_4124862_1_opt1190483\"\n                                class=\"fld_4124862_1 option-required\"\n                                name=\"fld_4124862[opt1190483]\"\n                                value=\"declar ca datele introduse sunt reale si pot dovedi asta\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_4124862_1\"\n                                                                data-calc-value=\"declar ca datele introduse sunt reale si pot dovedi asta\"\n                            >\n                    declar ca datele introduse sunt reale si pot dovedi asta                <\/label>\n\n                \t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"checkbox\">\n\t\t\t\t\n                <label                         for=\"fld_4124862_1_opt2609954\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_4124862_1\" data-parsley-multiple=\"fld_4124862_1\"                                type=\"checkbox\"\n                                data-label=\"sunt de acord sa fiu contactat pe email sau telefon\"\n                                data-field=\"fld_4124862\"\n                                id=\"fld_4124862_1_opt2609954\"\n                                class=\"fld_4124862_1 option-required\"\n                                name=\"fld_4124862[opt2609954]\"\n                                value=\"sunt de acord sa fiu contactat pe email sau telefon\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_4124862_1\"\n                                                                data-calc-value=\"sunt de acord sa fiu contactat pe email sau telefon\"\n                            >\n                    sunt de acord sa fiu contactat pe email sau telefon                <\/label>\n\n                \t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5f50badb8318a_1-row-8\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_6473439\" class=\"form-group\" id=\"fld_6473439_1-wrap\">\r\n\t<label id=\"fld_6473439Label\" for=\"fld_6473439_1\" class=\"control-label\">Comentarii <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<textarea name=\"fld_6473439\" value=\"\" data-field=\"fld_6473439\" class=\"form-control\" id=\"fld_6473439_1\" rows=\"4\"  required=\"required\"  aria-labelledby=\"fld_6473439Label\" ><\/textarea>\n\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5f50badb8318a_1-row-9\"  class=\"row  last_row\"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_5776537\" class=\"form-group\" id=\"fld_5776537_1-wrap\">\r\n<div class=\"\">\r\n\t<input  class=\"btn btn-default\" type=\"submit\" name=\"fld_5776537\" id=\"fld_5776537_1\" value=\"Trimitere\" data-field=\"fld_5776537\"  >\n<\/div>\r\n<\/div>\r\n\t<input class=\"button_trigger_1\" type=\"hidden\" name=\"fld_5776537\" id=\"fld_5776537_1_btn\" value=\"\" data-field=\"fld_5776537\"  \/>\n<\/div><\/div><\/form>\r\n<\/div>\r\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-131","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/policlinica-amaradia.ro\/index.php?rest_route=\/wp\/v2\/pages\/131","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/policlinica-amaradia.ro\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/policlinica-amaradia.ro\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/policlinica-amaradia.ro\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/policlinica-amaradia.ro\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=131"}],"version-history":[{"count":6,"href":"https:\/\/policlinica-amaradia.ro\/index.php?rest_route=\/wp\/v2\/pages\/131\/revisions"}],"predecessor-version":[{"id":589,"href":"https:\/\/policlinica-amaradia.ro\/index.php?rest_route=\/wp\/v2\/pages\/131\/revisions\/589"}],"wp:attachment":[{"href":"https:\/\/policlinica-amaradia.ro\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=131"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}