{"id":21,"date":"2016-03-09T08:27:16","date_gmt":"2016-03-09T08:27:16","guid":{"rendered":"http:\/\/policlinica-amaradia.ro\/\/?page_id=21"},"modified":"2020-09-10T14:24:49","modified_gmt":"2020-09-10T11:24:49","slug":"chestionar-satisfactie","status":"publish","type":"page","link":"https:\/\/policlinica-amaradia.ro\/?page_id=21","title":{"rendered":"CHESTIONAR SATISFACTIE AMBULATORIU"},"content":{"rendered":"<div class=\"caldera-grid\" id=\"caldera_form_1\" data-cf-ver=\"1.9.6\" data-cf-form-id=\"CF5f50b463f170b\"><div id=\"caldera_notices_1\" data-spinner=\"https:\/\/policlinica-amaradia.ro\/wp-admin\/images\/spinner.gif\"><\/div><form data-instance=\"1\" class=\"CF5f50b463f170b caldera_forms_form cfajax-trigger\" method=\"POST\" enctype=\"multipart\/form-data\" id=\"CF5f50b463f170b_1\" data-form-id=\"CF5f50b463f170b\" aria-label=\"CHESTIONAR SATISFACTIE PACIENTI\" data-target=\"#caldera_notices_1\" data-template=\"#cfajax_CF5f50b463f170b-tmpl\" data-cfajax=\"CF5f50b463f170b\" 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=CF5f50b463f170b\" data-hiderows=\"true\">\r\n<input type=\"hidden\" id=\"_cf_verify_CF5f50b463f170b\" name=\"_cf_verify\" value=\"55b3b23722\"  data-nonce-time=\"1776313457\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F21\" \/><div id=\"cf2-CF5f50b463f170b_1\"><\/div><input type=\"hidden\" name=\"_cf_frm_id\" value=\"CF5f50b463f170b\">\r\n<input type=\"hidden\" name=\"_cf_frm_ct\" value=\"1\">\r\n<input type=\"hidden\" name=\"cfajax\" value=\"CF5f50b463f170b\">\r\n<input type=\"hidden\" name=\"_cf_cr_pst\" value=\"21\">\r\n<div class=\"hide\" style=\"display:none; overflow:hidden;height:0;width:0;\">\r\n<label>Web Site<\/label><input type=\"text\" name=\"web_site\" value=\"\" autocomplete=\"off\">\r\n<\/div><div id=\"CF5f50b463f170b_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=\"CF5f50b463f170b_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=\"CF5f50b463f170b_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=\"2016-03-09 08:27:16\" 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=\"CF5f50b463f170b_1-row-4\"  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\t<label id=\"fld_5745977Label\" for=\"fld_5745977_1\" class=\"control-label\">Serviciul medical: <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_5745977_1_opt1236382\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_5745977_1\" data-parsley-multiple=\"fld_5745977_1\"                                type=\"checkbox\"\n                                data-label=\"Medicina interna\"\n                                data-field=\"fld_5745977\"\n                                id=\"fld_5745977_1_opt1236382\"\n                                class=\"fld_5745977_1 option-required\"\n                                name=\"fld_5745977[opt1236382]\"\n                                value=\"Medicina interna\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5745977_1\"\n                                                                data-calc-value=\"Medicina interna\"\n                            >\n                    Medicina interna                <\/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_5745977_1_opt2078518\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_5745977_1\" data-parsley-multiple=\"fld_5745977_1\"                                type=\"checkbox\"\n                                data-label=\"Cardiologie \"\n                                data-field=\"fld_5745977\"\n                                id=\"fld_5745977_1_opt2078518\"\n                                class=\"fld_5745977_1 option-required\"\n                                name=\"fld_5745977[opt2078518]\"\n                                value=\"Cardiologie \"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5745977_1\"\n                                                                data-calc-value=\"Cardiologie \"\n                            >\n                    Cardiologie                 <\/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_5745977_1_opt1437562\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_5745977_1\" data-parsley-multiple=\"fld_5745977_1\"                                type=\"checkbox\"\n                                data-label=\"Diabet si boli de nutritie\"\n                                data-field=\"fld_5745977\"\n                                id=\"fld_5745977_1_opt1437562\"\n                                class=\"fld_5745977_1 option-required\"\n                                name=\"fld_5745977[opt1437562]\"\n                                value=\"Diabet si boli de nutritie\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5745977_1\"\n                                                                data-calc-value=\"Diabet si boli de nutritie\"\n                            >\n                    Diabet si boli de nutritie                <\/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_5745977_1_opt1949153\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_5745977_1\" data-parsley-multiple=\"fld_5745977_1\"                                type=\"checkbox\"\n                                data-label=\"Oncologie \"\n                                data-field=\"fld_5745977\"\n                                id=\"fld_5745977_1_opt1949153\"\n                                class=\"fld_5745977_1 option-required\"\n                                name=\"fld_5745977[opt1949153]\"\n                                value=\"Oncologie \"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5745977_1\"\n                                                                data-calc-value=\"Oncologie \"\n                            >\n                    Oncologie                 <\/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_5745977_1_opt1898078\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_5745977_1\" data-parsley-multiple=\"fld_5745977_1\"                                type=\"checkbox\"\n                                data-label=\"ORL \"\n                                data-field=\"fld_5745977\"\n                                id=\"fld_5745977_1_opt1898078\"\n                                class=\"fld_5745977_1 option-required\"\n                                name=\"fld_5745977[opt1898078]\"\n                                value=\"ORL \"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5745977_1\"\n                                                                data-calc-value=\"ORL \"\n                            >\n                    ORL                 <\/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_5745977_1_opt1201317\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_5745977_1\" data-parsley-multiple=\"fld_5745977_1\"                                type=\"checkbox\"\n                                data-label=\"Oftalmologie \"\n                                data-field=\"fld_5745977\"\n                                id=\"fld_5745977_1_opt1201317\"\n                                class=\"fld_5745977_1 option-required\"\n                                name=\"fld_5745977[opt1201317]\"\n                                value=\"Oftalmologie \"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5745977_1\"\n                                                                data-calc-value=\"Oftalmologie \"\n                            >\n                    Oftalmologie                 <\/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_5745977_1_opt1244428\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_5745977_1\" data-parsley-multiple=\"fld_5745977_1\"                                type=\"checkbox\"\n                                data-label=\"Pediatrie \"\n                                data-field=\"fld_5745977\"\n                                id=\"fld_5745977_1_opt1244428\"\n                                class=\"fld_5745977_1 option-required\"\n                                name=\"fld_5745977[opt1244428]\"\n                                value=\"Pediatrie \"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5745977_1\"\n                                                                data-calc-value=\"Pediatrie \"\n                            >\n                    Pediatrie                 <\/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_5745977_1_opt1810260\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_5745977_1\" data-parsley-multiple=\"fld_5745977_1\"                                type=\"checkbox\"\n                                data-label=\"Neurologie \"\n                                data-field=\"fld_5745977\"\n                                id=\"fld_5745977_1_opt1810260\"\n                                class=\"fld_5745977_1 option-required\"\n                                name=\"fld_5745977[opt1810260]\"\n                                value=\"Neurologie \"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5745977_1\"\n                                                                data-calc-value=\"Neurologie \"\n                            >\n                    Neurologie                 <\/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_5745977_1_opt1892295\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_5745977_1\" data-parsley-multiple=\"fld_5745977_1\"                                type=\"checkbox\"\n                                data-label=\"Psihiatrie \"\n                                data-field=\"fld_5745977\"\n                                id=\"fld_5745977_1_opt1892295\"\n                                class=\"fld_5745977_1 option-required\"\n                                name=\"fld_5745977[opt1892295]\"\n                                value=\"Psihiatrie \"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5745977_1\"\n                                                                data-calc-value=\"Psihiatrie \"\n                            >\n                    Psihiatrie                 <\/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_5745977_1_opt1830748\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_5745977_1\" data-parsley-multiple=\"fld_5745977_1\"                                type=\"checkbox\"\n                                data-label=\"Ginecologie \"\n                                data-field=\"fld_5745977\"\n                                id=\"fld_5745977_1_opt1830748\"\n                                class=\"fld_5745977_1 option-required\"\n                                name=\"fld_5745977[opt1830748]\"\n                                value=\"Ginecologie \"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5745977_1\"\n                                                                data-calc-value=\"Ginecologie \"\n                            >\n                    Ginecologie                 <\/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_5745977_1_opt1809572\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_5745977_1\" data-parsley-multiple=\"fld_5745977_1\"                                type=\"checkbox\"\n                                data-label=\"Dermatologie \"\n                                data-field=\"fld_5745977\"\n                                id=\"fld_5745977_1_opt1809572\"\n                                class=\"fld_5745977_1 option-required\"\n                                name=\"fld_5745977[opt1809572]\"\n                                value=\"Dermatologie \"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5745977_1\"\n                                                                data-calc-value=\"Dermatologie \"\n                            >\n                    Dermatologie                 <\/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_5745977_1_opt1678234\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_5745977_1\" data-parsley-multiple=\"fld_5745977_1\"                                type=\"checkbox\"\n                                data-label=\"Chirurgie Generala\"\n                                data-field=\"fld_5745977\"\n                                id=\"fld_5745977_1_opt1678234\"\n                                class=\"fld_5745977_1 option-required\"\n                                name=\"fld_5745977[opt1678234]\"\n                                value=\"Chirurgie Generala\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5745977_1\"\n                                                                data-calc-value=\"Chirurgie Generala\"\n                            >\n                    Chirurgie Generala                <\/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_5745977_1_opt1606308\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_5745977_1\" data-parsley-multiple=\"fld_5745977_1\"                                type=\"checkbox\"\n                                data-label=\"Urologie \"\n                                data-field=\"fld_5745977\"\n                                id=\"fld_5745977_1_opt1606308\"\n                                class=\"fld_5745977_1 option-required\"\n                                name=\"fld_5745977[opt1606308]\"\n                                value=\"Urologie \"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5745977_1\"\n                                                                data-calc-value=\"Urologie \"\n                            >\n                    Urologie                 <\/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_5745977_1_opt1968793\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_5745977_1\" data-parsley-multiple=\"fld_5745977_1\"                                type=\"checkbox\"\n                                data-label=\"Endocrinologie \"\n                                data-field=\"fld_5745977\"\n                                id=\"fld_5745977_1_opt1968793\"\n                                class=\"fld_5745977_1 option-required\"\n                                name=\"fld_5745977[opt1968793]\"\n                                value=\"Endocrinologie \"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5745977_1\"\n                                                                data-calc-value=\"Endocrinologie \"\n                            >\n                    Endocrinologie                 <\/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_5745977_1_opt1764000\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_5745977_1\" data-parsley-multiple=\"fld_5745977_1\"                                type=\"checkbox\"\n                                data-label=\"Fizioterapie \"\n                                data-field=\"fld_5745977\"\n                                id=\"fld_5745977_1_opt1764000\"\n                                class=\"fld_5745977_1 option-required\"\n                                name=\"fld_5745977[opt1764000]\"\n                                value=\"Fizioterapie \"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5745977_1\"\n                                                                data-calc-value=\"Fizioterapie \"\n                            >\n                    Fizioterapie                 <\/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_5745977_1_opt1111119\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_5745977_1\" data-parsley-multiple=\"fld_5745977_1\"                                type=\"checkbox\"\n                                data-label=\"Stomatologie \"\n                                data-field=\"fld_5745977\"\n                                id=\"fld_5745977_1_opt1111119\"\n                                class=\"fld_5745977_1 option-required\"\n                                name=\"fld_5745977[opt1111119]\"\n                                value=\"Stomatologie \"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5745977_1\"\n                                                                data-calc-value=\"Stomatologie \"\n                            >\n                    Stomatologie                 <\/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_5745977_1_opt1251471\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_5745977_1\" data-parsley-multiple=\"fld_5745977_1\"                                type=\"checkbox\"\n                                data-label=\"Medicina de familie \"\n                                data-field=\"fld_5745977\"\n                                id=\"fld_5745977_1_opt1251471\"\n                                class=\"fld_5745977_1 option-required\"\n                                name=\"fld_5745977[opt1251471]\"\n                                value=\"Medicina de familie \"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5745977_1\"\n                                                                data-calc-value=\"Medicina de familie \"\n                            >\n                    Medicina de familie                 <\/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_5745977_1_opt1670612\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_5745977_1\" data-parsley-multiple=\"fld_5745977_1\"                                type=\"checkbox\"\n                                data-label=\"Medicina muncii\"\n                                data-field=\"fld_5745977\"\n                                id=\"fld_5745977_1_opt1670612\"\n                                class=\"fld_5745977_1 option-required\"\n                                name=\"fld_5745977[opt1670612]\"\n                                value=\"Medicina muncii\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5745977_1\"\n                                                                data-calc-value=\"Medicina muncii\"\n                            >\n                    Medicina muncii                <\/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_5745977_1_opt1798678\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_5745977_1\" data-parsley-multiple=\"fld_5745977_1\"                                type=\"checkbox\"\n                                data-label=\"Laborator analize medicale\"\n                                data-field=\"fld_5745977\"\n                                id=\"fld_5745977_1_opt1798678\"\n                                class=\"fld_5745977_1 option-required\"\n                                name=\"fld_5745977[opt1798678]\"\n                                value=\"Laborator analize medicale\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5745977_1\"\n                                                                data-calc-value=\"Laborator analize medicale\"\n                            >\n                    Laborator analize medicale                <\/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  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\">Prestatia medicului: <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n<div class=\"\">\r\n\t\t\t\t\t<div class=\"radio\">\n\t\t\t\t<label data-label=\"foarte buna\" for=\"fld_6074664_1_opt11127\"><input type=\"radio\" id=\"fld_6074664_1_opt11127\" data-field=\"fld_6074664\" class=\"fld_6074664_1 option-required\" name=\"fld_6074664\" value=\"foarte buna\"   required=\"required\" data-radio-field=\"fld_6074664_1\" data-type=\"radio\" data-calc-value=\"foarte buna\" \/>\n\t\t\tfoarte buna\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=\"buna\" for=\"fld_6074664_1_opt1627182\"><input type=\"radio\" id=\"fld_6074664_1_opt1627182\" data-field=\"fld_6074664\" class=\"fld_6074664_1 option-required\" name=\"fld_6074664\" value=\"buna\"   required=\"required\" data-radio-field=\"fld_6074664_1\" data-type=\"radio\" data-calc-value=\"buna\" \/>\n\t\t\tbuna\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=\"satisfacatoare\" for=\"fld_6074664_1_opt2571523\"><input type=\"radio\" id=\"fld_6074664_1_opt2571523\" data-field=\"fld_6074664\" class=\"fld_6074664_1 option-required\" name=\"fld_6074664\" value=\"satisfacatoare\"   required=\"required\" data-radio-field=\"fld_6074664_1\" data-type=\"radio\" data-calc-value=\"satisfacatoare\" \/>\n\t\t\tsatisfacatoare\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=\"proasta\" for=\"fld_6074664_1_opt3948901\"><input type=\"radio\" id=\"fld_6074664_1_opt3948901\" data-field=\"fld_6074664\" class=\"fld_6074664_1 option-required\" name=\"fld_6074664\" value=\"proasta\"   required=\"required\" data-radio-field=\"fld_6074664_1\" data-type=\"radio\" data-calc-value=\"proasta\" \/>\n\t\t\tproasta\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=\"foarte proasta\" for=\"fld_6074664_1_opt5138751\"><input type=\"radio\" id=\"fld_6074664_1_opt5138751\" data-field=\"fld_6074664\" class=\"fld_6074664_1 option-required\" name=\"fld_6074664\" value=\"foarte proasta\"   required=\"required\" data-radio-field=\"fld_6074664_1\" data-type=\"radio\" data-calc-value=\"foarte proasta\" \/>\n\t\t\tfoarte proasta\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_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=\"CF5f50b463f170b_1-row-5\"  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=\"CF5f50b463f170b_1-row-6\"  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-21","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/policlinica-amaradia.ro\/index.php?rest_route=\/wp\/v2\/pages\/21","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=21"}],"version-history":[{"count":31,"href":"https:\/\/policlinica-amaradia.ro\/index.php?rest_route=\/wp\/v2\/pages\/21\/revisions"}],"predecessor-version":[{"id":636,"href":"https:\/\/policlinica-amaradia.ro\/index.php?rest_route=\/wp\/v2\/pages\/21\/revisions\/636"}],"wp:attachment":[{"href":"https:\/\/policlinica-amaradia.ro\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=21"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}